Ultimate Neck Pain, Back Pain & Sciatica Relief Strategies

How to Distinguish Between Rheumatoid Arthritis and Osteoarthritis: Ultimate Bad Back Strategies for Dealing with Chronic Pain Associated with RA and OA

Introduction

The previous two articles in this series analyzed and discussed rheumatoid arthritis (RA) in some detail. The link between chronic pain and RA was analyzed and the progression of the RA chronic pain complex was revealed. Particular attention was paid to small joint pain, usually involving the neck, hands, and feet in the early stages of the disorder, then spreading as the disease takes hold and progresses. The progression of chronic, often acute pain affecting the larger joints, to include the upper, middle, and lower back, hip and knee pain, and even leg pain, usually expressed as sciatica, was discussed. As discussed in “Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part I & II,” RA is a chronic and systemic disorder, widespread throughout the body, and without cure. In this article we will discuss the differences between rheumatoid arthritis (RA) and an often misdiagnosed, misunderstood “cousin,” osteoarthritis (OA). We will discuss diagnostic features distinguishing the two disorders, the symptoms of RA versus OA, and some treatment variations and similarities. The very different outcomes, or prognoses, as well as certain strategies for confronting the two conditions head on will also be explored. Finally, strategies for alleviating, and in some cases eliminating, the chronic pain associated with rheumatoid arthritis and osteoarthritis will be offered. Chronic pain treatment strategies, to include treatment for neck pain, back pain, hip and knee pain, and sciatica, will be compared and analyzed.

RA Revisited

As noted above, rheumatoid arthritis is a chronic, systemic disorder. Rheumatoid arthritis is an autoimmune disease occurring when the individual’s immune system doesn’t work properly or malfunctions. Rheumatoid arthritis causes chronic, often acute pain, stiffness and swelling, and progresses from small joint involvement, to large joint involvement, and ultimately to multiple organ consequences. Chronic pain associated with RA is usually the result of an inflammation of the synovial membrane, synovitis. The inflammation of the synovial membrane leads to friction, the friction leads to joint degeneration, which leads to more inflammation, which leads to more friction and joint degeneration. As the disease progresses, and begins to affect other organ systems, the result is usually total disability. The exact cause of rheumatoid arthritis has not been established. Many experts believe that RA may be the result of genetics, environment, and/or a number of other factors to include hormones and the body’s reaction or response to stress. Onset of RA typically occurs in women between the ages of 30 and 50 years of age. However, rheumatoid arthritis has been known to strike the very young, men, and certain ethnic groups, to include a disproportionately high number of Native Americans. RA is also seen in higher numbers among smokers. Rheumatoid arthritis is generally not attributed to such things as aging, trauma and injury or obesity. Beginning with small joint pain and stiffness, the disorder culminates in deformity and chronic, often acute, back pain, hip and knee pain, and sciatica.

What is Osteoarthritis?

Osteoarthritis (OA) is generally considered an age-progressive phenomenon. Sometimes called the “wear and tear” disorder, OA may also be attributed to injury, trauma, stress, and/or obesity. Osteoarthritis typically expresses with joint pain, stiffness, and loss of function and did decrease in the range of motion. Unlike rheumatoid arthritis, osteoarthritis generally affects weight bearing joints, particularly the spine, the pelvis or hips, and the knees. Chronic back pain, particularly of the lower back, and leg pain (sciatica) are quite common. However, OA may also be present in the neck, the hands, particularly the finger joints, and even the big toe. Osteoarthritis generally worsens later in the day or after considerable activity. Alternately, rheumatoid arthritis is generally known for morning stiffness or stiffness occurring as the result of a lack of activity or after periods of prolonged inactivity.

Demographics of RA vs OA

Significantly, while as many as 1.5 million individuals in the United States have been diagnosed with rheumatoid arthritis, over 20 million people have been diagnosed with osteoarthritis. While diagnosis for osteoarthritis is usually established with the use of x-rays, in some cases CAT scans, rheumatoid arthritis usually takes a more comprehensive battery of diagnostic tests to properly diagnose. RA sufferers may require extensive blood tests, x-rays, CAT scans, and in some cases even an MRI to properly diagnose the disorder. The very different symptoms of the two disorders, one systemic and the other a “wear and tear” disorder, are evident in the laboratory and radiographically (x-rays).

Similarities in Treatment of Rheumatoid Arthritis and Osteoarthritis

Treatment strategies for RA and OA are often remarkably similar. Although RA requires pharmacological intervention, generally in the form of disease-modifying anti-rheumatic drugs or DMARDs, to reduce stiffness and chronic pain, as well to inhibit joint damage, this should not be the only treatment strategy employed. DMARDs often take weeks, even months to build up in the bloodstream and fully take effect, so NSAIDs are often used synergistically, and as a stop-gap until DMARDs are effective. Osteoarthritis, on the other hand, may also be treated by NSAIDs. However, ibuprofen and acetaminophen are routinely prescribed for pain associated with osteoarthritis.

Treatment and Treatment Responses of RA and OA

In addition to medication, both rheumatoid arthritis and osteoarthritis are responsive to physical therapy and ice to reduce inflammation and swelling. Individuals suffering from RA or OA typically respond well to exercise. Exercise is particularly effective for RA sufferers in order to offset periods of inactivity and the stiffness associated with a sedentary lifestyle or simply the stiffness related to characteristic morning stiffness. Osteoarthritis, on the other hand, responds well to exercise for different reasons. Individuals affected by OA, a typically age-progressive, trauma, and stress related phenomenon, respond quite well to strengthening of the musculoskeletal system, particularly the core muscles responsible for posture and overall strength. As muscles atrophy, deterioration of the bones, particularly the vertebrae and weight-bearing joints, is quite common, leading to “wear and tear” and an exacerbation of the overall condition and subsequent degeneration. The degeneration leads to a constellation of chronic pain symptoms, to include neck pain, back pain, and sciatica.

The Consequences of Doing Nothing!

Ultimately, while etiology or cause of rheumatoid arthritis and osteoarthritis are quite different, symptoms, such as swelling, inflammation, stiffness, and chronic pain are characteristic of both conditions. Individuals suffering from RA and OA are affected by a progressive disorder, both leading to total disability if not properly treated. Individuals diagnosed with osteoarthritis, because of the very nature of the disorder, have a much better chance of alleviating and even eliminating the long-term effects. RA is, by its very nature, more problematic. That being said, individuals suffering from rheumatoid arthritis may take control of the outcome, their prognosis, by engaging in an aggressive, holistic treatment strategy, one typically designed to treat the symptoms, since etiology is still unclear. In both instances, medication, ice for inflammation, swelling, and to reduce pain, and a medically approved, individualized program of stretching and exercise should be commenced as soon as possible. Chronic pain associated with both conditions should be taken as a warning to do something, rather than to do nothing. To do nothing will exacerbate either condition, leading to further degeneration and the progression of both disorders and their symptoms, to include chronic pain in the form of joint pain, neck pain, back pain, and/or sciatica.

Rheumatoid Arthritis and Osteoarthritis Treatment Strategies and Solutions(continued tomorrow)!

These are some of the programs I recommend. I hope they help you as much as they helped me!

I hold degrees in history and anthropology. Graduating summa cum laude, I was awarded a doctoral fellowship to study for my PhD as a fellow at one of the nations top consortiums for physical anthropology, made up of Columbia University, NYU, CUNY, the American Museum of Natural History (AMNH), and others. I commenced my doctoral studies. Researching the spine and sacroiliac joint, reviewing and categorizing more than 15,000 modern and pre-Columbian skeletons to understand the age-progressive phenomena affecting humans as we grow older, and having had 14 major surgeries on my spine, I am in a unique position to understand the “back pain complex” as few others can, from the perspective of patient and scientist/researcher. I hope my articles help you better understand your “bad back/back pain” issues.

Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part II

A Review

As discussed in “Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part I,” rheumatoid arthritis or RA is a disease affecting millions of individuals around the world every year. RA leads to a constellation of symptoms including but not limited to small joint pain, neck pain, back pain, hip pain, knee pain, and leg pain, also known as sciatica. Approximately one per cent of the world’s population, one in ten thousand individuals, are affected by rheumatoid arthritis. There appears to be a significant, gender-based difference, with three to five times as many women as men presenting with symptoms. Significantly, Native Americans present with as high as six percent of the population affected with the disorder. This author found RA present in high numbers in skeletal samples of pre-Columbian, Native American populations at the William S. Webb Museum of Anthropology, University of Kentucky, Lexington. It is this author’s experience, based on extensive research, that this condition dates back to pre-historic times, yet an explanation for the high prevalence in Native Americans remains elusive. The greater incidence among smokers was also discussed and is noted once again. Although the link between smokers and RA appears robust, causality remains problematic.

Understanding Symptoms

Rheumatoid arthritis remains something of a conundrum with more questions unanswered than answered. One thing is certain, chronic pain associated with RA is very real and often leads to total disability, particularly as the disease progresses. Additionally, as areas beyond the smaller joints become involved, and neck pain, back pain, hip and knee pain, and even sciatica advance, the quality of life can and often does suffer, particularly in the latter stages of RA. As noted in Part I, RA is characterized by small joint involvement, usually involving the hands and feet in early stages, becoming widespread and affecting the larger joints and other organ systems as the disease progresses. RA is an inflammatory disease both chronic and systemic (widespread) in nature. The disease may express with a myriad of symptoms, and they may range from mild stiffness and discomfort, to chronic, systemic and even acute pain. It is not unusual in the latter stages of the disease for RA patients to be completely disabled.

Inflammation and the Synovial Membrane

As noted above and previously, rheumatoid arthritis is systemic and is a form of auto-immunity. RA is characterized by an inflammatory process affecting the synovial membrane, known as synovitis. The synovial membrane lubricates the joints and makes it possible for the cartilaginous surface of one bone to “glide” across the surface of another. Synovial fluid is the medium responsible for the effortlessness of this function, reducing friction as it lubricates the joint. Imagine placing a penny on your kitchen counter and sliding it with a little push; it would slide until friction slowed and eventually stopped it. Now, with synovial fluid present the penny would continue on and on as friction is reduced to almost zero. Synovial fluid is truly one of the body’s miracles, allowing joints to function in a virtually frictionless environment. However, when RA is present, the synovial fluid and consequently the synovial membrane becomes inflamed, causing friction. The friction leads to joint erosion, and the joint erosion leads to a breakdown of the joint capsule, leading to chronic pain, and deformity. The breakdown in the joint capsule, and the joint itself, exacerbates the deformity compounding the pain; and, thus we have a feedback look, constantly feeding upon itself as the pain grows more intense with each progression over time.

Morning Stiffness and Inactivity

Rheumatoid arthritis may present with symptoms to include inflamed and swollen joints, slight fever and pain affected areas warm to the touch, stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity. I will repeat the latter portion of that last sentence because it is worth repeating:

“…stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity.”

Why would I repeat that sentence? Prolonged inactivity of any kind, whether extended periods of bed rest, self-imposed inactivity, or inactivity as habit, the result of a sedentary lifestyle, will only lead to heightened stiffness, soreness, and chronic pain, particularly as they relate to pain in the hands and feet, neck and shoulders, back, hips and leg pain, and sciatica. With inactivity, whether as the result of a sedentary lifestyle or as an adaptive and protective mechanism due to acute and chronic pain, deformity, further erosion, loss of function, and finally disability often result.

Treatment Strategies for Swelling and Stiffness

Stiffness in the morning or after periods of moderate to prolonged inactivity is a telling characteristic of RA, distinguishing it from osteoarthritis. Morning stiffness may last as long as one to two hours in advanced cases. Failure to integrate a proper stretching and exercise program, particularly when stiff, may result in heightened stiffness, soreness, and chronic pain. Small joint pain, particularly in the neck, hands and feet, can be dealt with by engaging in a simple but effective stretching and exercise program. Stiffness and soreness in the larger joints, those of the shoulders, back, hips, and knees, can and should be attended to through a comprehensive stretching and exercise program, preferably one designed by someone knowledgeable when it comes to RA. Of course an individualized, medically-supervised program is always best. Additionally, ice is always indicated when soreness, swelling, and stiffness is present and/or ongoing. When pain is acute, whether hand, neck, shoulder, back, hip, knee, or leg pain (sciatica), ice should always be the first step in any inflammation pain reduction strategy, not heat!

A Two-Pronged Approach to Treatment

Ultimately, while we understand quite a bit about RA, there is no cure. However, as noted above, there are methods to alleviate the inflammation, stiffness and soreness, chronic pain, and many of the other symptoms associated with the disorder. The primary treatment strategy should be a two-pronged treatment approach designed to alleviate chronic joint pain symptoms, to include neck pain, back pain, hip and leg pain, and sciatica, and to offset, as much as possible, and prevent any further deterioration of the joints. The strategy must include medication, prescribed my your RA specialist, usually a specific anti-rheumatic medicine or medicines combined with anti-inflammatories, weight loss, podiatry for the feet, physiotherapy or physical therapy, various injections, again as prescribed, fish oil and certain natural bone and joint medications, ice, and exercise.

Prognosis and Lifestyle Change

While statistics are not encouraging, particularly as they relate to treatment and prognosis, the debilitating and disabling effects of RA may be delayed and, in many instances alleviated, through an intelligent, holistic treatment strategy including medication, alternative medicine treatment methods, lifestyle changes, to include weight loss and diet considerations, and, above all, exercise. The concert of treatment strategies, with its holistic approach, will aid in alleviating and in some cases eliminating, at least short-term, the debilitating impact of RA. Rheumatoid arthritis, with its chronic, inflammatory, and systemic pain expressions, to include neck pain, back pain, hip pain, and sciatica, is not the disabling diagnosis it once was, provided a holistic, individually-designed treatment strategy is engaged early on and followed conscientiously. In Part III we will explore deeper into the various aspects of rheumatoid arthritis, including some of the specific treatment strategies available for individuals suffering from this debilitating and disabling condition.

Rheumatoid Arthritis Treatment Strategies and Solutions Part II & Part III (continued tomorrow)!

These are some of the programs I recommend. I hope they help you as much as they helped me!

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Rheumatoid arthritis is a chronic, systemic, inflammatory disease that affects millions around the world every year. The constellation of symptoms, to include chronic joint pain and neck pain, back pain, and sciatica in the latter stages, is both debilitating and disabling.

The cause of RA, while understood, is not without aggravating factors. The symptomology is complex and the disease expressions are myriad. Not only is the pain chronic in the latter stages but it is wide spread, affecting joints throughout the body and hastening their degeneration. Treatment of RA is problematic. We will deal extensively with symptoms and treatment strategies in part two of this article series on RA.

Understanding Rheumatoid Arthritis: Dealing with the Chronic Pain Associated with RA Part I

Introduction to Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disease that affects millions of individuals around the world every year. Many RA sufferers express pain, not only in the smaller joints of the hands and feet, but neck pain, back pain, and even sciatica in severe manifestations. Approximately one per cent of the world’s population, one in ten thousand individuals, are affected by rheumatoid arthritis. There appears to be a significant, gender-based difference, with three to five times as many women as men presenting with symptoms. Interestingly, smokers appear to be at significantly greater risk than non-smokers, up to four times as many smokers as non-smokers exhibit the disorder, although the reasons for this disparity are not clear. Rheumatoid arthritis is characterized by morning stiffness, arthritis at three or more joint areas, arthritis of the hand joints, symmetrical arthritis, rheumatoid nodules, serum RF, and radiographic changes. Rheumatoid arthritis principally affects the joints, both large and small, but may impact other organs as well. Extra-articular expressions of RA, evident in as high as twenty-five percent of all individuals with the disorder, may impact the skin, lungs, kidneys, heart, blood and blood vessels, eyes, liver, and even the nerves. Rheumatoid arthritis may also lead to chronic fatigue, loss of appetite and weight, malaise, listlessness and, in some cases, a low-grade fever. Osteoporosis and lymphoma have also been diagnosed in patients with rheumatoid arthritis, although a causal link is still unclear. Given the constellation of symptoms, it is not surprising that pain is expressed as being widespread, ranging from mild to acute, and fleeting to often chronic, particularly in advanced stages.

The Underlying Cause of RA

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that specifically affects the smaller joints of the hands and feet in the earlier stages and involves the larger joints in the later stages. RA ultimately results in chronic pain over widespread areas of the body, to include neck pain, back pain, and sciatica. It is nonsuppurative but finally results in the destruction of cartilage and joints. It also may produce lesions of the heart valves, pericardium, myocardium, and pleura. The pathophysiologic manifestations appear to result from the development of antibody against IgG. IgG makes up about 80% of the antibodies in plasma. Plasma is the fluid portion of blood. IgG is a crucial actor in the body’s ability to respond to and fight and sort of antigen, foreign matter in the body. These antibodies, called rheumatoid factor, belong to the IgM, IgG, and IgA classes. The rheumatoid factor or RF is present in eighty-five to ninety percent of individuals with rheumatoid arthritis. RA may be stimulated by a self-antigen; or an antigen in the synovial cavity, the space between the joints where fluid to lubricate the joints is present and necessary for movement; or an infective antigen, foreign agent or body causing an adverse reaction. The rheumatoid arthritis continues to interact with IgG even in the absence of any specific antigen or invading foreign body. Chronic antigen stimulation, such as occurs in chronic respiratory infections, causes the production and destruction of large amounts of antibody needed to fight infection. The RF-IgG complexes are present in the rheumatoid lesions and apparently activate complement or prostaglandins or other substances that promote the inflammatory response. The inflammatory response may vary in degree and location depending on the myriad of factors, to include age at onset and location of the specific inflammatory response. In older RA sufferers, the pain is frequently felt in the neck and deep in the low back, among other areas, even resulting in sciatica in severe incidents of low back pain spreading into the buttocks and legs.

Why Rheumatoid Arthritis Leads to Chronic Pain

The arthritis associated with RA is due to an inflammation in the synovial capsule, specifically of the synovial membrane. Synovial fluid is crucial for joint movement and, when synovitis is present, the joints become stiff, swollen, and extremely painful. We will discuss rheumatoid arthritis’s impact on the body, and its many extra-articular expressions, to include areas most affected by deformity, loss of function, and pain. Treatment strategies for rheumatoid arthritis include a multitude of factors, clearly a holistic approach is required. Pain, first localized in the smaller joints, particularly those of the hand, spreads and grows in intensity as the disease progresses until finally pain is chronic and widespread. The fact that RA impacts the joints exacerbates degeneration and consequently leads to often acute and chronic neck pain, back pain, and sciatica in the latter stages of the disorder. Specific strategies for dealing with this disorder, beyond those medications prescribed, will be discussed in the next article on this topic. Until then, know that relief is possible and long lasting, provided certain strategies are implemented and adhered to. Again, we will discuss those in part two, tomorrow.

Rheumatoid Arthritis Treatment Strategies and Solutions in Part II!

These are some of the programs I recommend. I hope they help you as much as they helped me!

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