Osteoarthritis, Aging, and the Back Pain Complex

Osteoarthritis (OA) is the most frequently diagnosed musculoskeletal condition in people over 50 years of age.

OA is the arthritis of your parents and grandparents and arthritis-related spine pain is responsible for debilitating levels of neck pain, back pain, and sciatica in millions of people worldwide.

Osteoarthritis or OA is generally characterized by focal degeneration of the joint cartilage and new bone formation at the base of the cartilage lesion, the subchondral bone, and at the joint margins, often referred to as bony spurs, bone spurs or osteophytes.

The Historical Record and OA

Interestingly, osteoarthritis occurs in all mammals. Osteoarthritis is the earliest documented human disease and the earliest human skeletons shown evidence of OA. In research I conducted at the Cleveland Museum of Natural History (CMNH), the American Museum of Natural History (AMNH), the National Museum of Natural History (NMNH), The Smithsonian, and the University of Kentucky, Lexington osteoarthritis was evident and, in fact, pervasive in modern and pre-Columbian skeletal samples. It is evident that OA has been around as long as we have, at the very least.

There are two types of OA, primary and secondary. In this article, we will be dealing with the probable etiology, the cause or causes for OA. We will also talk briefly about subcategories of OA, to include localized, generalized, and erosive osteoarthritis. Finally, we will discuss how OA affects spine-related pain or what I refer to as the back pain complex (i.e., neck pain, back pain, and sciatic nerve pain or sciatica).

Once again, osteoarthritis, as it affects the spine, is responsible for spine-related pain, meaning neck pain, back pain, and sciatica.

Localized osteoarthritis presents with Heberden nodes, but without other joint involvement, and is the most common form of OA. Studies of families demonstrate genetic factors being of importance in the development of Heberden nodes. This presentation of OA has to do with the distal interphalangeal joints, is localized primarily in the distal (away from the wrist) finger and toe joints, and affects women more than men. The interesting thing about Heberden nodes, sometimes mistakenly called Herberden, after William Heberden (1710-1801) is that they are a calcifc node, an osteophyte…osteophytes develop as a result of wear and tear at the joint and can be found wherever advanced osteoarthritis is found.

Generalized osteoarthritis was named by R. Moore in 1952 is defined by involvement of three or more joints or joint groups, for example the distal interphalangeal joints (DIP) are grouped and counted as one group. The DIP, proximal interphalangeal joints (PIP), first carpometacarpal (CMC), spine, knee, and hip joints are commonly involved. Other features of generalized osteoarthritis include predilection for postmenopausal women and episodic joint inflammation. See: (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2022370/?page=6).

Generalized osteoarthritis is also labeled as primary, generalized OA and, once again, is recognized by the involvement of several joints or joint groups, as noted above.

In most instances, generalized OA presents in the knees, spine, hips, OA also affects the fingers and the big toe. Interestingly, the shoulders, elbows and wrists are generally not involved in the generalized form of OA.

Secondary osteoarthritis is generally thought to have an underlying cause or that the patient has a predisposition to secondary OA. The underlying conditions of secondary osteoarthritis associated with etiology include a myriad of other arthritis-related contributory conditions, such as excess weight and/or obesity, injury, overuse of the affected joint, and much more.

Secondary OA, for the purposes of understanding neck pain, back pain, and sciatica, seems a more significant, contributory factor.

Once again, osteoarthritis, what your grandparents and parents used to call arthritis, is the most common type of degenerative joint disease.

OA is essentially a consequence of wear and tear or trauma and shouldn’t be confused with rheumatoid arthritis or RA, the second most common form of more than 100 forms of arthritis. In one series, 15% of erosive osteoarthritis patients subsequently fulfilled criteria for a diagnosis of rheumatoid arthritis or RA. I have dealt with RA extensively at here at Ultimate Neck Pain, Back Pain, and Sciatica Relief Strategies.

Osteoarthritis has many causes, to include recurrence minor joint damage, repetitive motion injuries, and specific joint-related trauma.

Osteoarthritis presents when the cartilage wears down between the bones, at the joints, and the bone begins to undergo changes as a result of trauma. Without adequate cartilage bones rub together at the joint causing pain and stiffness.

OA affects more than 27 million adults in the United States alone, and affects more women than men. Additionally, osteoarthritis results in neck pain, back pain, hip pain, and knee pain, in millions of people around the globe every year.

Interestingly, while the majority of OA sufferers are 50 years of age or older, there are also millions of affected individuals in their 30s and 40s.

In spite of what you may have heard, osteoarthritis is not inevitable. Being proactive, and integrating an activity and exercise program into your daily regimen will help offset the effects and the neck pain, back pain, hip pain, knee pain, and other related joint pain associated with osteoarthritis.

Overall osteoarthritis has multiple causes, affects individuals 50 years of age and older more frequently, and depending on the type of osteoarthritis, may affect men or women more frequently.

The five factors play a big part in etiology, particularly excess weight and/or obesity, muscle weakness, and dehydration. However, diet and nutrition is also thought to play a big part on contributing to and exacerbating OA, and consequently neck pain, back pain, and sciatica.

We will explore the five factors and OA in subsequent articles and videos.

Contact me anytime!

John

Professor John P. J. Zajaros, Sr., The Bad Back Guy
216-539-7412
Skype: johnzajaros1
johnz@ultimatebadbackstrategies.com

PS, For a program guaranteed to help you deal effectively with osteoarthritis related neck pain, back pain, hip pain, and knee pain, got to http://TheBadBackGuy.net and discover real and lasting pain relief! Guaranteed!

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Degenerative Disc Disease and Neck Pain, Back Pain, and Sciatica Treatment and Relief: Part II

Contrary to what many in the medical community would have you believe, degenerative disc disease is not a disease at all, it is a condition. In fact, degenerative disc disease is a symptom of a breakdown in the overall health of the musculoskeletal system, generally. And, it is a symptom of deterioration in the health of the spine, specifically. Significantly, degenerative disc disease is an age-progressive phenomenon affecting millions worldwide, one of the primary causes of neck pain, back pain, and sciatica, primarily as we age.

Let me restate my main points:

• Degenerative disc disease is not a disease, it is a condition!

• Degenerative disc disease is an age-progressive phenomenon. Or, more accurately, it is an age-progressive constellation of phenomena.

• Degenerative disc disease is actually several phenomena, meaning there are several age-related factors working against us, and our spines, in concert as we age.

• Degenerative disc disease is age-progressive, behavioral, and preventable!

There are many factors that come into play, affecting the musculoskeletal system generally, and the spine specifically. Consequently, some of the factors affecting spine health contribute to degeneration of the spine generally and the intervertebral discs (IVDs or discs), specifically; and, there is a ripple effect as the breakdown in one system impacts and affects the next, and so on.

The degeneration of the spine leads to specific and often serious consequences. Some of the consequences associated with spinal degeneration include structural changes, as in the case of degenerative disc disease.

Some of the structural changes include:

• Bony spurs, also known as osteophytes. Osteophytes generally appear in direct response to stress or a traumatic event. The overall appearance of osteophytes,
and the associated bridging (a fusion or near-fusion of osteophytes across the intervertebral space), mimics the curvatures of the spine in frequency, with the secondary curvatures being more commonly affected. The secondary curvatures being those of the cervical (neck) and lumbar (lower back) regions. The presence of osteophytes may be asymptomatic, meaning no pain or other symptoms are apparent, or they may lead to neck pain, back pain, and/or sciatica, depending on the level and severity.

• Stenosis. Stenosis is a narrowing of various spinal openings, known as foramen, by the deposition of bone. Bony deposition may also be a consequence of ossification and/or calcification of connective tissue adjacent to the foramen. The intervertebral foramen allow the spinal nerve roots to exit the spinal canal. Pressure, stress and/or trauma on and of the nerve roots, either as a consequence of stenosis or as a result of bulging or herniated discs, will often lead to neck pain, back pain, and/or sciatica, depending on the severity and the level of the spine affected.

• Osteoarthritis. Osteoarthritis may cause abnormal bone deposition, often leading to stenosis, osteophytosis (the creation of osteophytes), and neck pain, back pain, and sciatica. Osteoarthritis generally affects the secondary curvatures with greater frequency and intensity, particularly as we age. In our 60s, 70s, and 80s osteoarthritis may be every bit as common a factor in neck pain, back pain, and sciatica as degenerative disc disease. In fact, the often co-present in the same individual and are interrelated.

• Changes to the intervertebral discs. Changes to the IVDs occur as a consequence of the five factors mentioned above, all five contributing to degenerative disc disease, and other age-progressive phenomena, such as osteoarthritis and osteophytosis, also affected by the five factors. Changes in the intervertebral discs is one of the primary causes of neck pain, back pain, and sciatica.

• Connective tissue damage, including ossification and calcification. The reasons for a breakdown in the connective tissue associated with the spine can in large measure be traced back to the five factors. However, factors such as ankylosing spondylitis, rheumatoid arthritis, and several other conditions, diseases, and traumatic events may contribute to a breakdown of the connective tissue, particularly the spinal ligaments. The breakdown of the spinal ligaments is one of the principle factors contributing to degenerative disc disease and neck pain, back pain, and sciatica.

• The vertebrae (vertebral bodies). As stress transfers from the muscles to the connective tissue and on to the intervertebral discs, the stress and associated trauma adversely affects and impacts the vertebrae. When the vertebrae are adversely affected by stress and trauma meant to be handled by other components of the musculoskeletal system generally, and the spine specifically, the vertebrae undergo structural changes. Often when the vertebrae are stressed, osteophytes and osteophyte bridges occur. The osteophytes may be an adaptive response on the part of the spine to stress normally handled by the musculature, connective tissue, and intervertebral discs.

The structural changes listed above, incomplete as the list may be, provides a window into how interconnected and interrelated the spine is as a living system and how one component’s health directly affects the overall spine health.

As noted above and in part one, some of the factors contributing to a breakdown of spine health include:

• Excess weight and/or obesity

• Muscle weakness

• Muscle imbalance

• Inadequate diet and nutrition

• Dehydration

The five principle factors listed above, along with other contributory factors, negatively impact the musculoskeletal system and place stress on the spine generally, and its components individually. Consequently, stress on the spine often creates a breakdown in the overall health of the system and degeneration of the individual components, including the intervertebral discs or IVDs (or more simply, the discs), thus leading to a myriad of consequences…including degenerative disc disease and neck pain, back pain, and/or sciatica.

As stated in part one, stress placed on the spine as we age may be traced, in part, back to excess weight and/or obesity. Excess weight sets in place a ripple effect throughout the spine. The excess weight often leads to exaggerated spinal curvatures. The exaggerated curvatures of the spine stress the musculature, particularly the core muscles of the lower back and abdomen. Muscle weakness leads to back strain and back sprains. Muscle weakness may also lead to muscle imbalance, although muscle imbalances may also occur in otherwise healthy individuals, something we will address in an upcoming article. Muscle weakness and muscle imbalance may also exacerbate neck pain, back pain, and sciatica.

Interestingly, muscle weakness and muscle imbalance may lead to exaggerated spinal curvatures. Exaggerated spinal curvatures may lead to muscle weakness and muscle imbalance. All four factors, excess weight and/or obesity, exaggerated spinal curvatures, muscle weakness, and muscle imbalance will lead to a breakdown in the connective tissue, particularly the spinal ligaments, and the intervertebral discs (IVDs), thus leading to degenerative disc disease. The vertebrae themselves are affected by the stress being transferred from muscle, to ligament, to IVD, to vertebral body, leading to osteophytosis and other bony changes.

All of the above related factors will result in neck pain, back pain, and/or sciatica, depending on the level of the spine affected. In later life, the health of the spine becomes adversely affected and debilitating pain and disability may result. The entire process is often accelerated by decades when the five factors work in concert and against the musculoskeletal system and the spine, leading to early onset degenerative disc disease and neck pain, back pain, and/or sciatica.

As the spinal system begins to break down, as demonstrated above, the impact is often across the board, meaning as one component breaks down they all do, one affecting the next. Degeneration of the intervertebral discs may and often does occur, thus leading to degenerative disc disease and neck pain, back pain, and sciatica.

In part three we will examine the final two factors, inadequate diet and nutrition, and inadequate hydration or dehydration. The final two factors to be examined are as important, if not more-so, depending on the individual. Diet, nutrition, and hydration may affect and impact not only the overall spine health but the body’s ability to heal and rebuild itself when stressed and during and after a traumatic event.

Ultimately, the five factors contribute to degenerative disc disease and neck pain, back pain, and/or sciatica, they must be dealt with in the context of an entire system and not as singular entities if neck pain, back pain, and sciatica treatment is to be effective and pain relief lasting.

To your health!

John

Professor John P. J. Zajaros, Sr., The Bad Back Guy
216-712-6526
Skype: johnzajaros1
johnz@ultimatebadbackstrategies.com

PS, Do you want to start right away? Are you ready to be rid of your neck pain, back pain or sciatica? Do you want to find real and lasting neck pain, back pain, and sciatica relief? Just click this link and start today!

PPS, Or go to my other neck pain, back pain, and sciatica blog and follow us, join us, as we create a new future in time for the New year…one without pain, one with real and lasting pain relief!

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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.

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