As one of the foremost experts on back pain and inflammatory conditions of the spine Dr. Borenstein has earned the recognition and praise of the medical community by being named an outstanding specialist in rheumatology in Washingtonian magazine and Best Doctors in America. He is past president of the American College of Rheumatology and author of author of several books on back and arthritis for both physicians and patients.
Ask The Expert About Back Pain
Q. Is there a link between low back pain - facet joint issues—and neck pain (both constant) and RA? Can a patient have ankylosing spondylitis simultaneously with RA, even if the blood marker isn’t present?
This question brings up a number of issues that involve the similarities and differences between ankylosing spondylitis and rheumatoid arthritis. Both are illnesses that are caused by abnormalities of the immune system, but the effect on the human body is different. Rheumatoid arthritis is an inflammatory arthritis that primarily attacks the peripheral joints like fingers and toes. The cervical spine may be affected later in the course of overwhelming severe disease attacking the synovial joints with loss of bone at he very top of the spine (C1-2) and the facet joints in the lower cervical spine causing instability (subluxation). Rheumatoid arthritis rarely attacks the lumbar spine.
Ankylosing spondylitis (AS) is an inflammatory arthritis that may involve the facet joints of the lumbar spine. However, the first area of involvement is the sacroiliac joints. The eventual result of the inflammation of AS is not bone erosion, but bone fusion, the exact opposite of RA. The entire spine may become involved with the inflammatory process resulting in fusion of the entire spine involving the facet joints, including those in the cervical spine.
Is it possible that both illnesses exist in a single patient and the answer is yes. It is easier to make both diagnoses if the individual is B27+ and rheumatoid factor or anti-CCP + and has involvement of fingers and toes and sacroilitis. In these unfortunate individuals, the most effective therapy would be an anti-tumor necrosis antibody which is effective in both illnesses.
Q. I have back pain and osteoarthritis. Can the pain that flares up be due to doing too much exercise? Specifically gardening.
Yes gardening can make the pain worse but there are things you can do to improve the pain.
Q. What is spinal stenosis?
Spinal Stenosis refers to narrowing in the spinal canal or neural foramina that puts pressure on the nerves within. Here is a good overview Spinal Stenosis
Q. What can I do to reduce my daily pain from fibromyalgia and arthritis
- Your question suggests that your bulging disks and back pain are causing you foot pain. All of us have bulging disks particularly at the end of the day. They might cause some back discomfort but would be an unlikely cause of foot pain. In order to affect both feet, nerve compression would be occurring on both sides of the spine with sciatica. which is not described in your complaints. What you describe suggests local problem with the feet. The foot is a very complicated structure. It is impossible to suggest any specific remedy without more specific facts. The fact that an ice bath helps suggests that swelling may occur and that is reversed by the cold temperatures. We walk on our feet every day and that ay make healing slower than we would like. Injections can weaken tissues and may not make them better over the long term. Staying with the program can have long term benefits.
Q. I started with a right side stiff neck, it then moved into my shoulder and upper back. All my right from my neck to my foot hurts now. I get spasms, burning sensations, stabbing pains etc. I was diagnosed with rheumatoid arthritis in June but my rheumatologist says all these symptoms cant be with rheumatoid arthritis. My gp keeps saying it's coming from tight muscles. Any ideas?
- Stiffness of muscles has become a common problem during the time of COVID-19 with or without RA. It would be unlikely that RA, for this duration, would be causing problems with the joints in the neck to cause a stiff neck. Computer time has increased as individuals are working longer hours at home. The trapezius muscle which is the large muscle on the side of the neck that runs from the back of the head to between the shoulder blades can become fatigued and will tighten and pain. As this muscle becomes more involved, it will recruit other surrounding muscles to support it. Low back pain can occur as a secondary problem because of increased sitting. I recommend for everyone, with or without RA, to get up on a regular schedule. Do gentle stretching of the neck and back muscles. Temperature applications, ice massage initially, or a heating pad, later for no longer than 10 minutes can help with muscle symptoms.
Q. Can playing too many sports cause rheumatic diseases? My son plays a lot of sports and always complains of wrist pain. Can playing too many sports cause rheumatic diseases?
- In general sports activities will not cause inflammatory arthritis. Sports can cause mechanical issues like ligament and tendon injuries that can cause arthritis years later. For more information about spine arthritis go to the spinecommunity.com for additional information. You can learn more about Rheumatoid Arthritis here.
Q. Should people with rheumatic conditions worry about running out of medicine? I am a 40 year old female. I want to know should people with rheumatic conditions worry about running out of medicine?
- In general, an adequate amount of medicines is available. The concern about hydroxychloroquine has been eased with the studies that show the absence of benefit of this drug to prevent and treat COVID-19. A large stockpile of this drug was put aside. It is now available for patients with rheumatoid arthritis and systemic lupus. Tocelizumab is a drug being used for patients who have severe COVID disease. Despite this use, no shortage of supply of this biologic has been reported. For ongoing information about drug supplies, you may get additional information on theSpineCommunity.com website
Q. I have been battling back pain for the past 10 years, and I'm 28! I feel like because of this age, I am often turned away for the pain I am experiencing, or getting an appointment can take 6 months. I will provide you with some back story, followed by my question. -S Shaped scoliosis of the thoracic/C-Spine @ T6-C7. -Normal lordosis -Loss of cervical curve -Multiple Subluxations -Gait abnormality -DDD - C/L-Spine -Minor Disc bulge C5-6, C6-7 -L4-5: Mild disk desiccation. Mild broad-based bulging disc and minimal degenerative facet hypertrophy I have been through multiple physical therapy treatments, chiropractic (not helpful), and acupuncture (helpful).
- Your history suggests a significant scoliosis with multiple subluxations. I get concerned in these circumstances whether excessive movement (hypermobility syndrome) is playing a role. Under those circumstances a physical therapist can be helpful. A spinal surgeon or rheumatologist may be helpful in monitoring the scoliosis and the exercise routine
Q. I am in chronic, sometimes debilitating pain with flare ups from the base of my skull to my inner hips. I get tingling on my face, as well as to my finger tips occasionally, and have great difficulty with focusing, and memorization. I've blamed my anxiety medication for these two issues, and was then also prescribed Adderall to stay focused at my mentally straining job. I have seen a medial doctor yearly since this began, all with different additions to my diagnoses. The only doctor I have yet to see is a rheumatologist.
- A number of your symptoms seem neurologic in origin like tingling in the face. I believe a neurologist may be most helpful in that setting. They can determine if it is more a brain versus a spine problem.