Neuro Diseases: Arthritis in the Spine

Introduction

Arthritis in the spine is common.

Arthritis means inflammation of the joint and it may be due to any number of causes including degenerative, infectious and inflammatory causes.

Examples of arthritic conditions of the spine

• Osteoarthritis
• Septic
• Rheumatoid
• Psoariatic
• Ankylosing spondylitis etc

Osteoarthritc condition is generally thought to be related with long standing wear and tear phenomenon and has a predilection for large weight bearing joints e.g. hips, knees, spine etc. Arthritis in lower spine is more common than the mid or upper areas, once again supporting the view that weight bearing joints like lower spine are more vulnerable. In general lumbar, sacral, and cervical spine are affected more frequently as compared to thoracic spine.

Septic, rheumatoid, psoriatic arthritic conditions are not as common as osteoarthritis in the spine but do occur. Outside the spine these do not necessarily affect the weight bearing or the large joints.

Septic one results due to infection spread to the joint usually bacterial. Although this involves large weight bearing joints even smaller joints may be involved too.

Rheumatoid arthritis does have a predilection for smaller joints especially the hand joints. It also involves then somewhat symmetrically. When it involves the spine the neck (cervical spine) area is mostly affected and more specifically it is the atlantoaxial joint (joint between the 1t and 2nd cervical spine) that is involved.

Psoariatic arthritis also can involve non weight bearing joist like finger or toes in addition to the spine.

Ankylosing spondyltis has a predilection for sacroiliac joints and the lower spine area.

What are the usual symptoms?

Patients with spinal arthritis will present with chronic history of pain & muscle stiffness in the back.

If there is pinching of the spinal nerve roots then radiating pain to the limbs are experienced. Numb feeling and pins & needles in the extremities also may occur.

In severe cases when conditions like spinal stenosis, myelopathy (spinal cord damage), cauda equina, conus medullris syndromes then muscle weakness, severe back symptoms, bowel and/or bladder disturbances can occur (please click the link below on “neurology articles” for more on these conditions)

Diagnosis (tests ordered on case to case basis)

• Characteristic history
• Examination findings
• Radiological studies (x-ray, CT, MRI etc)
• Joint fluid analysis
• Certain blood tests (rheumatoid factor, blood culture, HLA studies, ESR, ANA)

Treatment for Arthritis in the Spine (modality chosen on case to case basis)

• Pain killers – NSAIDs (e.g. Tylenol, diclofenac), opioids (e.g. oxycontin), muscle relaxants (e.g. baclofen), nerve pain pills (e.g. gabapentin)
• Steroids (e.g. prednisolone) & Immunosuppressive agents (e.g. methotrexate)
• Antibiotics (for septic type)
• Physical therapy as needed and tolerated
• Surgical options (if conservative treatment fails) e.g. joint replacement.

A neurologist is commonly involved in the management of the arthritis of the spine.

Arthritis in the Spine to Neurology Articles

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