Rheumatoid arthritis and back pain

RA is an autoimmune condition that causes swelling and pain in joints with synovial tissue throughout the body.

In most cases, spine pain occurs as a result of instability between the C1 and C2 vertebrae. This instability can cause pressure on the spinal cord or a vertebra to slip out of place, which usually means that the upper vertebra slides over the lower one. Doctors call this spondylolisthesis.

If slipped vertebrae put pressure on the sciatic nerve in the lower back, it can cause sciatica.

Sciatica can lead to difficulty walking and loss of coordination. However, vertebrae that are unstable or have severe damage can also press on other vital parts of the body. If a person does not get treatment, cervical spine RA can have severe consequences, including stroke.

Although less common, RA may also affect the facet joints in the spine. The paired facet joints run all along the spine. They connect with the bony bumps that a person can feel when they run their hands down their back. Facet joints support movement and flexibility in the spine.

RA-related inflammation in the facet joints can cause back pain. In some cases, extended inflammation can destroy the facet joints. As a result, the vertebrae become less stable.

Anyone with RA must seek treatment for their back pain to prevent further damage from occurring.

Treatments for back pain due to RA focus on relieving pain and preventing further damage:

Home treatments

People can relieve RA-related back pain at home using the following treatments and remedies:

1. Ice packs

Massaging the area with cloth-covered ice packs for 5–10 minutes at a time within the first 48 hours of feeling the pain may help ease it. For pain that lasts longer than 48 hours, a person should try applying heat to help the muscles relax.

2. Anti-inflammatories

Taking over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce stiffness and help lower back pain that RA is causing.

People with RA should always check with their doctor before taking any new medications.

3. Gentle stretches

A person should try performing gentle stretching exercises and staying as mobile as possible. While resting at the first sign of pain may be beneficial, movement can help prevent excessive stiffness and discomfort in the back.

Water-based exercises and stretches may be beneficial because the water helps to support the joints, making it easier to move them.

4. Stress relief

People can take steps to relax and relieve anxiety. Stress can worsen pain and lead to muscle tension.

The following activities can help to relieve stress and tension:

• meditation
• journaling
• listening to peaceful music
• watching a favorite film or program
• talking with friends

5. Lifestyle choices

Taking steps to achieve better overall health can help people with RA pain. Doctors will almost always recommend quitting smoking, if applicable, as this is one of the best ways to reduce the risk of RA or RA flare-ups, according to research.

Other lifestyle choices such as reaching or maintaining a moderate weight may also enhance a person’s quality of life when they have RA and back pain. Following an anti-inflammatory diet can also help.

6. Alternative therapies

Some people also benefit from massage therapy and physical therapy.

Medical treatments

A doctor may evaluate a person’s back pain to determine if the causes are RA-related.

They may recommend imaging studies to identify whether specific joints in the spine appear to have inflammation or damage, which could indicate that RA is causing the back pain.

7. Medication

If a person is experiencing significant back pain caused by RA, a doctor may prescribe medication, such as disease-modifying antirheumatic drugs (DMARDs) or biologic agents.

These medications do not cure RA, but they can slow its progression. This can help prevent severe damage to the spinal joints.

8. Surgery

In some cases, a person’s back pain indicates severe problems with the back joints. Some people may need surgery to reduce pain and prevent further disability.

The surgical approach depends on a person’s symptoms and where they feel the pain. Examples of surgeries include laminectomy, or spinal fusion. However, doctors rarely recommend spinal surgery for RA. Usually, medications such as DMARDs are able to help a person maintain or increase joint function.

RA in the back usually affects the cervical spine, which refers to the top seven vertebrae, including the neck.

However, RA can also affect other areas of the spine, such as the lumbar region in the lower back.

Some of the symptoms associated with RA and back pain include:

• headaches
• joint swelling, but not usually in the hips or neck
• loss of joint function and movement
• pain, especially at the base of the skull
• stiffness in the back
• warmth around the affected joints

As RA progresses, it is more likely that people will experience symptoms in their spine.

One study estimated that nearly 33% of people with RA might experience lower back pain. Other estimates suggest that more than 80% of people with RA experience spinal problems, some as early as 2 years after diagnosis.

The research findings on this may be conflicting. A more recent 2021 review showed the prevalence of back pain in general to be nearly 34%. However, it found little evidence of RA as a common cause.

How does rheumatoid arthritis affect the middle back?

RA can cause inflammation in the facet joints, which could lead to pain in the middle or upper back.

If a person does not get treatment, this could also cause spondylolisthesis, a condition that occurs when a vertebra slips out of position. Although spondylolisthesis usually affects the lower back, it can cause pain in the middle or upper back as well.

Can RA affect the thoracic spine?

RA usually affects the cervical spine, which is at the top of the spinal cord. However, it can also cause inflammation in the facet joints of the thoracic spine, which may worsen back pain.

Although uncommon, a 2019 review noted there have been reports of spinal stenosis, or a narrowing of the spaces in the spine, occurring in the thoracic spine in people with RA.

What are good RA back pain exercises?

A person can use many exercises to help relieve back pain associated with RA.

For example, yoga or tai chi can increase flexibility, balance, and stability while also reducing stress levels. Water exercises such as swimming or aerobics may also ease stiffness and pain while improving range of motion.

While there is no cure for RA, doctors can prescribe medications to slow its progression and recommend surgeries that can prevent severe complications due to RA-related spine damage.

Anyone with RA who experiences back pain should talk with their doctor or rheumatologist because the pain may be related to RA.