Diagnosis Of Back Pain
Regardless of what type of doctor you see, there are some things you can expect your doctor to do during your visit. Your doctor first will ask you a number of questions, the most common of which are listed as follows:
- What are your symptoms–that is, what aches or pains do you have?
- Exactly where is the pain?
- Where is the pain the most severe?
- When did the pain begin?
- How long have you had it?
- Did something specific cause your back pain, such as an accident or injury?
- What home treatments have you used?
- Were you under any additional stress when the pain began?
- Do you have any other health problems?
- What kind of work do you do?
- In what types of recreational activities do you participate?
Think about these ahead of time so you can answer them easily. You also may have questions you’d like to ask the doctor. As you think of questions at home, jot them down and take them to the appointment.
Next, your doctor will give you a physical exam. During the exam, the doctor may perform any of the following: observe your muscles and joints ask you to sit and lie down ask you to move your back in different positions observe and feel the area of most pain and/or check to see if other areas of your body are tender or painful If the doctor can identify the likely cause of your back pain at this point, no further tests will be needed.
How Does Ra Cause Back Pain
RA is an autoimmune condition that causes swelling and pain in joints throughout the body. It can affect the facet joints in the spine.
The paired facet joints run all along the spine. They connect with the bony bumps that a person can feel when they run their hands down their back. Facet joints support movement and flexibility in the spine.
RA-related inflammation in the facet joints can cause back pain. In some cases, extended inflammation can destroy the facet joints. As a result, the vertebrae become less stable.
Instability in the spine can cause a vertebra to slip out of place, which usually means that the upper vertebra slides over the lower one. Doctors call this spondylolisthesis.
If slipped vertebrae put pressure on the sciatic nerve in the lower back, it can cause sciatica.
Sciatica can cause:
- loss of bowel or bladder function
- loss of coordination
- pain that radiates to the arms and legs
However, unstable or severely damaged vertebrae can also press on other vital parts of the body. If left untreated, cervical spine RA can have severe consequences, including:
As RA progresses, it is more likely that people will experience symptoms in their spine.
One study suggests that around 64.5 percent of people with RA may experience lower back pain. The researchers found that people with RA and lower back pain reported a lower quality of life, and that some were at increased risk for depression.
Rheumatoid Arthritis Of The Spine
Rheumatoid arthritis is an autoimmune disorder, meaning that the immune system turns on itself. It attacks synovium the lining of the joints. Although rheumatoid arthritis is more common in other joints, it can also affect the spine, specifically the cervical region . Rheumatoid arthritis of the spine is not caused by wear and tear, so its considered an inflammatory arthritis. It may cause back pain even when these joints are not in use. It tends to affect women more than men.
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Increased Risk For Disability Poor Quality Of Life And Depression
While low back pain may not be severe, its effects can be significant. People who are diagnosed with both RA and low back pain tend to report higher rates of disability, lower quality of life, and more symptoms of depression.2,6
Treatment to alleviate chronic pain and improve everyday function may increase quality of life and reduce symptoms of depression.
Spinal Arthritis Causes And Risk Factors
The causes of arthritis in the back or neck vary depending on the type of arthritis you have. Besides normal wear and tear and autoimmune triggers, in many cases the exact cause remains unknown. Genetic components have been identified in connection with some forms of spinal arthritis, meaning that it may be hereditary.
Other spinal arthritis risk factors include:
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Excess weight/obesity
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Presence of certain conditions such as diabetes, gout, psoriasis, tuberculosis, irritable bowel syndrome and Lyme disease
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Ra Rarely Attacks The Joints Of The Lower Spine
Rheumatoid arthritis causes the bodys immune system to attack the lining of synovial joints. However, it is rare for RA to attack the synovial joints of the lower spine,4 which connect vertebrae to each other and to the pelvis .
Rheumatoid arthritis is more likely to affect the lower spine in other ways.
Read more about Lumbar Spine Anatomy and Pain on Spine-health.com
Treatment For Rheumatoid Arthritis
While there isnt a cure for rheumatoid arthritis, it can typically be managed with medication and lifestyle changes.
Depending on how severe your RA is, your doctor may recommend medication like:
- Nonsteroidal anti-inflammatory drugs .
- Disease-modifying antirheumatic drugs .
- Biologics.
There are medications that can help with the pain of rheumatoid arthritis, help the patient become more functional, reduce inflammation and actually slow the progression of rheumatoid arthritis, says Dr. Bunyard.
Having a lifelong illness like RA may make you feel like you dont have control over your life. Focus on making lifestyle changes, finding a treatment option thats right for you and talking to your doctor about any challenges you face.
Were trying to keep people active, employed and doing all the things that they want to do or should be doing, assures Dr. Bunyard. The goal of treatment is to keep peoples lives as normal as possible.
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When You Think Of Ra You Dont Usually Think Of Pain In The Back But Ra Can Affect Certain Parts Of The Spine
While rheumatoid arthritis most commonly affects the peripheral joints such as those in the hands, feet, and knees some people with RA also report experiencing back pain.
Keep in mind, though, that if lower back pain is your primary symptom, its likely not due to RA. Several types of inflammatory arthritis affect the spine, most notably spondyloarthropathies such as psoriatic arthritis and ankylosing spondylitis, in which back pain is one of the main symptoms of the disease.
To help demystify back pain among people with rheumatoid arthritis, we asked Marcy Bolster, MD, associate professor of medicine at Harvard Medical School and director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital, to answer questions many RA patients have when they find themselves dealing with back pain.
Physical And Occupational Therapy
Physical therapy helps you to restore joint function through specific exercise. This can help alleviate pain for many patients. Activities like cooking and bathing can sometimes be difficult to perform and may cause pain. Occupational therapy will help you to learn how to change some of your daily behaviors so they arent painful.
Other professional therapy services that can help alleviate pain include massage therapy and acupuncture.
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How To Handle Rheumatoid Arthritis Pain
While you may not be able to avoid the pain that comes with rheumatoid arthritis , you can take action to limit it. Start with these eight ideas:
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How Is Spinal Arthritis Treated
The treatment for spinal arthritis depends on many factors. They may include your age, level of pain, type and severity of arthritis and personal health goals. Because the joint damage caused by arthritis is irreversible, the treatment usually focuses on managing pain and preventing further damage.
Nonsurgical treatments for spinal arthritis may include:
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Nonsteroidal anti-inflammatory drugs and corticosteroids to reduce pain and swelling
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Other medications targeting specific symptoms or triggers of inflammatory arthritis
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Physical therapy to improve back muscle strength and range of motion in the spine
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Lifestyle changes to reduce inflammation or stress on your spine: losing weight, quitting smoking, changing your posture, etc.
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Diagnosing Ra Back Pain
Dealing with back pain when you have RA can be challenging. Your back pain might not be the result of chronic disease. However, trying to push through pain by yourself is never a good idea. If you do have an underlying autoimmune condition like RA, your physical health could deteriorate, and, in the worst-case scenario, cause chronic pain or permanent disability. The earlier a doctor can diagnose and begin treating your symptoms, the better chance you have of maintaining your quality of life.
When you visit your doctor for a differential diagnosis, you will likely undergo physical and imaging exams. Your physician may ask questions about which parts of your body are affected and how long youve had your symptoms to determine whether your pain is acute or a chronic expression of an underlying condition. They may also ask you to move in certain ways to assess your range of motion.
If your doctor believes your pain is due to RA, they may also order imaging tests to see any bone, nerve, or spinal cord damage for themselves. Common tests include X-rays, magnetic resonance imaging , and ultrasound.
How To Manage Ra Pain: 9 Tips
Most people with rheumatoid arthritis have some pain. You can take steps to keep it from stopping you.
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What Can I Do
Learn about back pain and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self-management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.
Stay active and healthy. Your back is designed for movement. Continuing with your normal activities or returning to them as soon as you can will help you recover from a bout of back pain. Some pain with activity is normal but does not mean it is causing harm. You may need to rest or reduce some activities when the pain is excessive. But resting for more than a day or two usually does not help and may do more harm than good. See a physiotherapist or exercise physiologist for advice about exercises to keep your back moving. If you are carrying extra kilos, losing weight with the help of a dietitian may be of benefit, as may be strategies to reduce stress and anxiety.
Learn ways to manage pain. There are many things you can try, including
Acknowledge your feelings and seek support. It is natural to feel worried, frustrated, sad and sometimes angry when you have pain. Be aware of these feelings and get help if they start affecting your daily life.
Symptoms Of Rheumatoid Arthritis
While rheumatoid arthritis affects everyone differently, some common symptoms include:
- Pain, swelling, stiffness and tenderness in more than one joint.
- Stiffness, especially in the morning or after sitting for long periods.
- Pain and stiffness in the same joints on both sides of your body.
- Fatigue.
More than 1.3 million people in the U.S. have RA. It typically starts to develop between the ages of 30 and 60. Some people may have joint symptoms develop over the course of a few years, while others may have symptoms that progress rapidly.
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Evening Primrose Oil Supplements
Some plant oils may reduce pain and stiffness associated with RA. Evening primrose oil contains an essential fatty acid called gamma-linolenic acid that may provide some relief.
A 2016 study found that taking evening primrose oil and fish oil may reduce inflammation and disease activity.
According to the National Center for Complementary and Integrative Health , however, more research is needed on the effectiveness of primrose oil.
Again, check with your doctor before taking evening primrose oil, as it may interact with some medications. Potential side effects include headache and an upset stomach.
Thunder god vine grows in China and Taiwan and is used in traditional Chinese medicine. Research has indicated that it may be effective for treating RA symptoms.
According to a 2015 study , thunder god vine was comparable to the standard RA drug methotrexate in relieving symptoms. The study found that taking both was even more effective.
A 2018 research review also suggested that thunder god vine supplements may help reduce inflammation. Still, more research is needed on long-term effects and safety.
Talk to your doctor and assess the benefits before trying thunder god vine, as it may have some serious side effects. These can include reduced bone mineral content, infertility, rashes, and hair loss.
Thunder god vine can also be poisonous if it isnt prepared correctly.
Rheumatoid Arthritis: How To Protect Your Joints Reduce Pain And Improve Mobility
This Special Health Report, Rheumatoid Arthritis: How to protect your joints, reduce pain and improve mobility, gives you the information you need to work with your physician to design a treatment plan. Youll learn how rheumatoid arthritis affects joints and how it is diagnosed and treated, as well as the variety of symptoms that may occur. You’ll find information on established medical therapies as well as complementary treatments such as acupuncture, yoga, and dietary supplements. A special section provides advice about how to care for yourself through adaptations in your personal and work life, useful gadgets, and smoking cessation.
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How Common Is Ra Back Pain
When back pain is RA related, inflammation in the cervical spine is usually the cause.
RA primarily affects peripheral jointssuch as in the hands, feet, and kneesbut the cervical spine is the second most common region that’s affected.
The spine is affected when RA progresses. In other words, inflammation in the back and spine may indicate a more advanced disease. However, the damage can be seen on X-rays as early as two years after diagnosis.
A 2015 report suggests that more than 80% of people with RA have some cervical spine involvement.
Although pain in the lumbar spine, or low back, is not commonly a part of RA, it’s associated with RA. This means that if you have RA, it’s common to also have low back pain.
A 2013 study reported that up to 65.5% of people with RA may experience low back pain. The researchers also noted that people with RA who had low back pain reported lower quality of life and had an increased risk for depression.
A 2017 report in the German medical journal Zeitschrift für Rheumatologie also found that low back pain in those with RA led to a higher degree of disability.
How Do We Tell What The Cause Of Joint Pain Is In An Ra Patient
When a rheumatologist sees a patient with RA and pain is their primary complaint, the first step is often to assess how active the synovitis or inflammation component due to RA is since treatment of this is important not only to prevent pain but also to prevent further joint damage. Rheumatoid arthritis inflammation is often associated with prolonged morning stiffness of 1-2 hours, whereas an osteoarthritic joint will be painful and stiff for only a few minutes on waking and then get worse with use over the day. The rheumatologist will also assess the degree of inflammation by feeling the number of tender and swollen joints and performing blood tests that indicate general inflammation levels .
It is often difficult in patients with long-standing disease to determine whether persistent RA inflammation or osteoarthritis is the problem in any one joint, and this may be especially difficult in large joints such as the knee. As stated above,often more than one problem is present.
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