Rheumatoid Arthritis (RA) is the one of the most debilitating type of arthritis because it can cause severe 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 (joint lining) causing inflammation of this membrane. This inflammation triggers the release of chemicals causing the synovial membrane to thicken. Over time, these chemicals and enzymes can destroy cartilage, bone, tendon, and ligaments.
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/back pain, numbness, or weakness in the arms or legs. The disease can also cause joint swelling, stiffness, loss of joint motion and muscle strength, fatigue, loss of appetite, fever, and difficulty sleeping.
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. Imaging studies may include Xrays, CAT scans or MRIs to evaluate the structures of the spine or joints.
Most RA patients can be treated nonsurgically. Although there is no cure, there are medications that can relieve symptoms and slow disease progression. They may include nonsteroidal anti-Inflammatory drugs (NSAIDs), corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressants, and antidepressants. Physical Therapy (PT) can help restore muscle strength and flexibility, improve mobility and coordination, and maintain body functions through exercise. Surgery may be indicated when there is uncontrollable pain combined with neurologic dysfunction, cervical spine instability, or severe weakness resulting in functional disability.