Rheumatoid Arthritis (RA) is the most debilitating type of arthritis because it can cause deformity and disability. Its actual cause is unknown; however, it is thought to develop when white blood cells, whose normal duty is to provide immunity, turn against the synovial membrane (which lines the joints) causing inflammation of this membrane. This inflammation triggers the release of chemicals causing the synovial membrane to thicken. Destructive enzymes in the synovial fluid create a granulated membrane (pannus) that covers the normal joint surface. Over time, these chemicals and enzymes can destroy joint cartilage, bone, tendons, and ligaments. As these structures are compromised, the joint loses it shape and alignment.
Symptoms: RA rarely affects the cervical and/or lumbar spine; however, when the cervical or lumbar spine is involved, the patient's symptoms may include headache, neck pain, paresthesias, weakness in the arms and legs, and paraparesis. The disease can also cause joint swelling, pain, stiffness, loss of joint motion and muscle strength, fatigue, loss of appetite, fever, and difficulty sleeping.
Diagnosis: An evaluation for RA includes a physical examination and careful history assessing the patient's joint inflammation, mechanical difficulty, pain severity, range of motion, instability, misalignment, and deformity. The physician may order lab tests to determine the presence of an inflammatory process in the body, (the RA factor), complete blood count, an analysis of the synovial fluid, and a urinalysis. A hepatic panel may be required to assess liver and pancreatic function. These tests provide a baseline and insight into the patient's general health. A neurologic evaluation includes assessment of the patient's symptoms, including motor and sensory function, pain, numbness, paresthesias, muscle spasm, weakness, and bowel/bladder changes.
Treatment: Most RA patients can be treated nonsurgically. Although there is no cure, there are medications that can relieve symptoms and slow disease progression. The medication recommended by the physician is based on the patient's medical condition, age, other drugs the patient currently takes, safety, cost, and patient preference. They may include nonsteroidal anti-Inflammatory drugs (NSAIDs), COX-2 inhibitors, corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressants, and antidepressants. Physical Therapy can help restore muscle strength and flexibility, improve mobility and coordination, and maintain body functions through exercise. Massage, hydrotherapy, and other modalities can help relieve pain. Surgery may be indicated, when there is uncontrollable pain combined with neurologic dysfunction, myelopathy from cervical spine instability, or severe weakness resulting in functional disability. The goal in this surgery is to remove the offending tissue pressing on the spinal cord or neural elements and to make the spine more stable.
For more information about spine related conditions and treatments, visit the UCLA Spine Center at at spinecenter.ucla.edu.