FAQs on Arthritis – Extremities & Spine

Arthritis is a disease that affects the joints, causing pain, stiffness, and loss of movement. The root “arth” means joint, and “itis” means inflammation, which used together means joint inflammation.

There are over 100 types of arthritis, which affect people of varying ages. Inflammation of the body is a response to an injury or infection. The National Arthritis Data Workshop reports that around 27 million adults in the U.S. suffer from osteoarthritis, and rheumatoid arthritis affects approximately 1.3 million Americans.

Other types of arthritis that affect the spine and extremities include spondylarthritides (0.6 to 2.4 million U.S. adults), gout (8 million U.S. adults), Sjogren’s syndrome (0.4 to 3.1 million U.S. adults), and polymyalgia rheumatic (711,000 U.S. adults).

What causes arthritis?

During an inflammatory reaction, the body’s defense cells (the immune system) rush to an injured or infected area to clean up and repair tissues that are affected. The inflammatory process usually goes away, and the area is renewed and healthy once again. With arthritis, the inflammation never goes away, but rather continues to persist and damage healthy body structures, such as cartilage.

What is the most common type of arthritis?

Osteoarthritis (OA) is the most common type of arthritis. This disease results in breakdown of cartilage, and mainly affects the knees, hips, feet, and spine. Experts report that osteoarthritis affects all persons over the age of 60 years to some degree.

Which is the most disabling type of arthritis?

Rheumatoid arthritis (RA) is considered to be the most disabling type of arthritis. This condition affects women three times as often as men, and usually develops between ages 25 and 50 years.

While rheumatoid arthritis usually affects the finger and wrist joints, it can affect the spine, knees, and hips. With this form of arthritis, the joint lining becomes inflamed and thickens, which results in destruction of bone and cartilage. The goal of treating RA is preventing further joint deterioration.

What types of arthritis affect the spine?

There are several conditions related to spinal arthritis. With facet joint arthritis, the facet joints (between the vertebrae and spine) become inflamed from progressive degeneration. When this occurs, there is less flexibility and mobility of the spine.

When bone spurs (osteophytes) form on the facet joints, they cause nerve irritation or entrapment of nerves, which pass through the spinal structures to the lower extremities. This is referred to as spinal stenosis. When arthritis occurs in the lower spine and sacroiliac (SI) joint, it is called lumbosacral arthritis.

Who is at risk for arthritis of the extremities and spine?

There are several factors that contribute to the development of arthritis. These include:

  • Advancing age
  • Excessive weight
  • Family history
  • Playing certain sports

What interventional treatment measures are used for spinal arthritis?

The treatment of arthritis depends on the joint that is affected. Several options exist for spinal arthritis, including:

  • Epidural steroid injection (ESI) – This procedure involves the instillation of a long-acting corticosteroid into the spinal epidural space, which is done using x-ray guidance. According to recent studies, patients can expect a 90% success rate if symptoms have been present for less than three months, and an 80% success rate if symptoms have been present longer than three months.
  • Facet joint injection (FJI) – With this procedure, needles are positioned into the facet joint space near the spine using x-ray guidance. Once in position, the doctor injects a long-acting anesthetic with or without a steroid. Recent clinical studies show that 80-85% of patients reported functional improvement and significant pain relief after FJI.
  • Sacroiliac joint injection – In this procedure, the doctor injects an anesthetic and steroid medication into the SI joint, which alleviates pain related to arthritis of the very low back area. In a recent research study, 70% of patients reported pain relief and improved functional ability following this injection.

 

Resources

Borenstein D (2014). Does osteoarthritis of the lumbar spine cause chronic low back pain? Current Pain and Headache Reports, 8(6), 512-517.

Helmick CG, Felson DT, Lawrence RC, et al (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States- Part I. Arthritis & Rheum, 58(1):15-25. Retrieved from: http://www.rheumatology.org/ACR/about/newsroom/prevalence/prevalence-one.pdf

Lawrence RC, Felson DT, Helmick CG, et al. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States- Part II. Arthritis & Rheum, 58(1):26-35. Retrieved from: http://www.rheumatology.org/ACR/about/newsroom/prevalence/prevalence-two.pdf

Liliang PC, Lu K, Weng HC, Liang CL, Tsai YD, & Chen HJ (2009). The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine, 34(9):896-900.

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5:191-201