Rheumatoid Arthritis

Rheumatoid = inflammation and pain in joints, muscles, or soft tissue
Arthritis = inflammation, pain and stiffness in joints

Rheumatoid arthritis (RA) is a disease that causes painful and stiff joints. RA can affect any joint in the body. At The Spine Hospital at The Neurological Institute of New York, we specialize in treating RA of the spine.

RA is an autoimmune disorder, which means the damage is caused when the immune system mistakenly attacks healthy tissue. RA differs from osteoarthritis in that osteoarthritis (often just called “arthritis”) results from wear and tear on the joints.

RA may start in one part of the body and progress to others. There is not a universal pattern as to how the disease progresses, what joints will be affected, and the severity of the involvement of each joint.

When RA affects the spine, it is more common for the cervical spine (neck) to be affected than other portions of the spine. RA can affect the cervical spine as early as the first two years of the disease’s onset. Sometimes it affects the spine much later, and sometimes it never involves the spine at all.

RA in the spine can cause the following symptoms:

• Neck and/or back pain (depends on area affected)
• Swelling of joints
• Warmth around the joints
• Headaches and pain at the base of the skull (if RA is present in cervical spine)
• Painful and stiff joints
• Loss of flexibility and function of joints

In progressive forms of RA, the deterioration of the joints in the spine can result in the spinal cord and/or spinal nerve roots becoming compressed (pinched). The symptoms of compression vary depending on the portion of the spine that is affected. These symptoms may include:

• Loss of coordination or changes in the ability to walk
• Loss of bowel or bladder function
• Pain that radiates to the arms and legs
• Muscle weakness

Patients with severe RA typically have multiple affected joints in the hands, arms, legs, and feet. Inflammation of the eyes, mouth and lungs can also develop.

Although the cause is unknown, it is suspected genes and environment play a role in developing RA.

There is research to support the involvement of certain genes, called HLA class II genes, in the development of RA.

Environmental factors may include smoking, exposure to certain bacteria or viruses.

RA can affect anyone, but it is more common in women. It usually presents in middle age and is most common in older people.

A physician may perform the following tests to confirm the diagnosis of RA:

• Physical exam
• Lab tests:
  • Rheumatoid factor (RF) – the doctor will draw a blood test to run RF to determine the level of RF antibody in the blood. High levels of RF are most often indicative of RA.
  • Anti-cyclic citrullinated peptide (anti-CCP) – the doctor will draw a blood test to run Anti-CCP. When a patient is positive for Anti-CCP and RF, it is likely he/she has RA and may be more likely to have a more rapidly progressing and severe form of the disease.
  • Erythrocyte sedimentation rate (ESR) – The doctor will draw blood to run an ESR to determine how much inflammation is in the body.
• X-rays – test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Ultrasound scanning – useful in diagnosing RA as it provides images of damaged joints typically seen in RA.

Although there is no cure, there are many treatments available to help reduce symptoms of RA.

A doctor may prescribe the following medications to provide relief of symptoms and improve joint function in the spine:

• Non-steroidal antiinflammatory medications (NSAIDs). This class of medication reduces inflammation. NSAIDs include ibuprofen (Advil, Motrin) and celecoxib (Celebrex).
• Disease-modifying antirheumatic drugs (DMARDs). This class of medication decreases inflammation and slows the progression of RA. DMARDs include methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
• Biologic agents (sometimes referred to as biologic DMARDs). This class of medication suppresses certain substances in the body that cause inflammation and joint damage involved in RA. Biologic agents include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra), and tofacitinib (Xeljanz).

In rare cases, surgery may be required when RA has greatly affected the joints in the spine. If the deterioration of the joints in the spine has led to compression of the spinal cord or instability of the spine, the goal of surgical intervention is to decompress the spinal cord and stabilize the spine. The surgeon may perform a laminectomy to remove the lamina, which is the bone that covers the spinal canal. Removing the lamina makes room for the spinal cord. In some cases, the surgeon may perform a spinal fusion to ensure the spinal column is stable after surgery. During a spinal fusion, the surgeon may place new bone and allow the bones to fuse together (fusion).

The doctor will discuss the available treatment options and will tailor the treatment to each patient and situation.

Drs. Paul C.  McCormick, Michael G. Kaiser, Alfred T. Ogden, Christopher E. Mandigo and Patrick C. Reid at The Spine Hospital at The Neurological Institute of New York are experts in treating rheumatoid arthritis. They can also offer you a second opinion.