back pain

back pain ,tell me if I have got this wrong .I thought y,ou did not get back pain with rd I have had pain in my back and hips today thing just keep getting better not

[earthwitch]

I think you are right - inflammatory back pain is, by definition, spondyloarthritis, rather than RA, though it is possible to have mechanical (injury or degeneration-related) back pain that is coincidental with RA. In the UK it seems that too many rheumatologists ignore back pain if the rest of your symptoms fit with RA, even when its seronegative. Spondyloarthritis is always seronegative, and just doesn't seem to be diagnosed early or often in the UK - especially in women. If you think your back pain might be inflammatory, then check out the signs of inflammatory back pain on the nass.org.uk website, and if you do fit the criteria for it, ask your rheumatologist whether they have considered inflammatory back pain or a spondyloarthritis diagnosis either instead of or in addition to RA.

I might be a sceptic, but I do wonder if one of the reasons spondy is less often diagnosed and the term seroneg arthritis preferred is because of treatments - with spondy (AS or PsA) the first line treatment is NSAIDs, and then you jump straight to antitnfs, whereas with RA there is a huge range of relatively cheap DMARDs that would be tried first before moving to antitnfs. Spondy back pain typically isn't helped by DMARDs, which only tend to be useful for hand and feet (peripheral) involvement.

The other feature of spondyloarthritis that is different from RA is enthesitis - inflammation at the points where tendon joins bone, which is a different place to the synovitis of RA (which happens within the joint). So things like plantar fasciitis, achilles tendonitis, costochondritis and hip bursitis are really common with spondy. Enthesitis points do overlap with fibro tender points too, which means that frequently people get told fibro first and its only when they see a really clued up rheumatologist it actually gets recognised as enthesitis.

[Hidden in reply to earthwitch]

thank you for such a great detailed and helpful response ,this is a credit to the site ,and has given me much needed help.

[Hidden in reply to earthwitch]

HI... Am very interested in reading the link but I am getting up a steel industry site on your link. Could be Im from another country but I dont see why that would affect it. Or maybe the auto writing changed it when you were typing?? Do have have another one? Many thx

-gail

[Kim-NRAS NRAS in reply to Hidden]

Hi Gail

The correct web address for NASS is nass.co.uk/

BW

Kim

[Hidden in reply to Kim-NRAS]

Thanks heaps Kim.. I will take a look at it

[Izzybellamaree in reply to Hidden]

nras.org.uk

[Nildesperandum]

I have exactly the same pain. Terrible stiffness in my lower back and hips. I emailed my rheumatologist to ask and she said that my inflammation levels weren't high so it couldn't be RA. MTX seems to be working fairly well for my hands and feet.

Am I understanding Earthwitch correctly, that spondyloarthritis wouldn't show in inflammation levels

I don't know where to go from her to get someone to take me seriously!

[helixhelix in reply to Nildesperandum]

I don't know as much about spondy as Earthwitch, but Spondy is seronegative rather than non-inflammatory. So you will be negative for things like the RF factor, but it does cause inflammation so you are likely to have a raised ESR & CRP.

But it's one of the catch 22 aspects of all these inflammatory diseases that the fact that you're in pain and with no energy means that you probably move less than you used to, so you sit more and it tends to weaken muscles - and any wear & tear in your back or joints is exacerbated. So even if you don't have spondy you end up with back and/or hip pain as well as everything else!

I'm also convinced that the inflammation process does seem to encourage osteoarthritis, as mine seems to have raced ahead since I was diagnosed with RA. I now have 3 crumbled vertebrae in my back and worn out knees and quite a lot of the time I have more pain from these bits of osteoarthritis than I do from the Rheumatoid. But exercise and trying to keep fit really does help more than anything else. If I don't do anything for even I couple of days I really feel it.

[Hidden]

My back & hips are painful as well. I asked my rheumy about it last week & he said that it wouldn't be RA.

He examined my back, he got me to bend down to try & touch my toes which didn't hurt. He then got me to arch backwards & that did hurt! He said that revealed it was OA with the discs getting squashed - ho hum - can't win can we!!!??

[Hidden]

There are places in each vertebrae of the spine that RA/RD affects and thats called the facet joints. They have synovial membranes which can become inflammed in people with RA/RD. I know because as well as cord compression I have had cysts, abscesses and inflammation problems in the facet joints so they ended up doing Rhizotomies during each of my fusions. Its true most people have OA in those joints but here is a basic way to tell the difference, its taken from the Laser Spine Institute website...

"It is important not to get this condition confused with spinal rheumatoid arthritis, which is an autoimmune disease characterized by the body attacking its own synovial membranes on joints. Rheumatoid arthritis causes the facet joints to become painfully inflamed. One way to tell the difference between facet joint osteoarthritis and rheumatoid arthritis is to ask yourself if the pain you feel in your spine ever seems warm — if so, you may be experiencing rheumatoid arthritis rather than facet joint arthrosis."

laserspineinstitute.com/bac...

[Hidden in reply to Hidden]

Should have added that an MRI of the spine will tell you what is going on.

[Hidden in reply to Hidden]

thank you for your input a mri would be helpful

[Hidden in reply to Hidden]

Thats OK... I was thinking...

When I had a full body bone scan, as well as other places, my spine lit up with inflammation. But because I have a lot of hardwear there, it makes it difficult to see specifics however they said I also had enthesitis come up in quite a few areas so that might be an option too.. they could tell if there is inflammation in the sacroilliac joint ( which I didnt have) or hips (which I did) to help with diagnosis. But MRI is the gold standard for looking at the spine to get detail.

[Glyn612]

HI earthwitch. Your post is really interesting. I've been suffering a lot from lower back and hip pain, and I also have pain in my left ankle, which even steroids haven't touched. I recently had an injection in my coccyx for coccyx pain, which seemed to do the trick, but hasn't done anything for the hip and back pain. I have to sit on a coccyx wedge cushion to work, which pushes my hip forwards. I have inflammatory sero negative arthritis, and have recently started taking MTX - too early yet to know whether it's going to work. I also have shoulder bursitis and have had several steroid injections. The consultant was considering surgery on the shoulder but thinks that the MTX will improve that. I've recently had an MRI on my spine and hips, and am awaiting the results, but it will probably be early December before I get to see my rheumy again with the results. I'm wondering whether I should research spondyloarthritis and enthesistis as these seem to fit my symptoms.

[Hidden]

Hi all

I have had a "bad back" for years and have been told a few time you can't get RA in your back. My pain got so bad last year I was struggling to walk, it was in my hip and groin. I thought it was a flare in my hip. I had x rays and an ultrasound scan of my hips which showed milk OA. My rheumy said it's your back and prescribed painkillers and physio. I eventually had an MRI which showed amoungst degeneration, OA and Tarvol cysts, Facet Joint Hypertrophy. I looked it up and it is indeed caused by RA. My back is classically stiff first thing. I've just had a depo and bingo my back is so much less stiff. Whoopee! Wouldn't it be great to feel this way all the time? Hope you get some answers June bee x x

[Hidden in reply to Hidden]

thank you for your reply. ra brings so many problems but people still dismiss it as nothing even pip have dismissed it and I now have a stressful appeal to go through and as we all have a uncertain future with the things to come.

[Hidden in reply to Hidden]

I hope you win your appeal June. Fingers crossed x

[Hidden]

June Im sorry you are having so many problems, yes RA can be both painful and inconvenient but at least they are finding out more and more about it so there they can help and give us hope for better treatments

Kiki is so right in what she said, so I thought I might add to my previous post in regard to RA not affecting your spine.... I guess its like everything, unless the doc is a specialist in the area then when they tell people that "its not posssible, RA cant be in your back" they could be unknowingly misinforming. Granted its not your typical reason for back pain so it isn't often considered, but maybe it should be if they cant find another reason and you have RA.

I have lots of problems with my spine and its true I have OA as well as RA, but I was told by the Neurosurgeons that they have seen the damage from RA in my facet joints, it looks different from OA and often produces cysts etc as well. This was not once, but several times by two different Neurosurgeons before and after they operated on me.

Below is a good description of RA in Facet joints in a cervical video but can equally be referred to in the lumbar region (short ..approx 45 secs).

dailymotion.com/video/xjyxb...

I have had these synovial cysts drop up from time to time and had them aspirated or done rhizolysis (radiofrequency ablation) on them since age 46:

medscape.com/viewarticle/53...

More:

ncbi.nlm.nih.gov/pmc/articl...

tasmanspine.com.au/patient-...

June I do hope you find out the reason for your back pain, no matter what the cause is.... its very draining and you need some sort of answers so you can address it.

Best of luck