There are many potential causes for back pain, including injuries, strain, or even physical exercise. But when aches last for weeks or months, it may be time to rule out temporary injury and start looking for an underlying condition.
If you have rheumatoid arthritis (RA) — a chronic autoimmune disease best known for causing inflammation and damage in the hands, wrists, and knees — you may think your condition is also having a negative effect on your spinal health. In some cases, this may be true, but for the most part, spinal changes in people with RA are not due to inflammatory arthritis.
Here’s what to know, including other potential causes of your back pain, and ways to find relief.
Rheumatoid arthritis is a systemic, inflammatory disease that affects roughly 1 percent of the global population. As an autoimmune disease, the symptoms of RA occur when the body's immune system begins targeting the joints and causing inflammation. These attacks damage the joint tissue and can lead to chronic pain, deformity, and limited mobility.
The cervical spine is the very top of the spine, in the neck. Its joints, C1 and C2, are surrounded by synovial fluid. Because RA attacks the synovium, these joints are at risk of inflammation, damage, and pain from RA. It’s not unusual for RA to cause inflammation in the spinal joints C1 and C2 — around 80 percent of people with rheumatoid arthritis show signs of cervical spine inflammation.
However, 64.5 percent of people with RA report having chronic lower back pain. For people with pain in the thoracic and lumbar spine (middle and lower back), the cause isn’t inflammatory disease activity from RA — but it may be related to your RA in other ways. Arthritis in the feet, hips, or knees from rheumatoid arthritis can cause undue strain on the back and accelerate the development of structural arthritis (osteoarthritis) in the spine. In addition, medications used to treat rheumatoid arthritis, such as steroids, can affect spinal health and lead to backaches.
Outside of these possibilities, there are countless other reasons that someone might experience back pain alongside RA. Common culprits include:
When rheumatoid arthritis affects the spinal joints, it can cause neck pain, as well as radiating aches that travel into the legs and arms. Common symptoms of RA-related damage to the cervical spine may include:
If you experience any of these symptoms, talk to your primary care physician or rheumatologist. They will be able to assess your rheumatoid arthritis, and if necessary, update your treatment plan to address spinal symptoms.
If you have aches or pains in your lower or middle back, it’s also a good idea to speak with your doctor about your symptoms. They can help determine the cause and recommend ways to find relief.
Dealing with back pain when you have RA can be challenging. Your back pain might not be the result of chronic disease. However, trying to push through pain by yourself is never a good idea. If you do have an underlying autoimmune condition like RA, your physical health could deteriorate, and, in the worst-case scenario, cause chronic pain or permanent disability. The earlier a doctor can diagnose and begin treating your symptoms, the better chance you have of maintaining your quality of life.
When you visit your doctor for a differential diagnosis, you will likely undergo physical and imaging exams. Your physician may ask questions about which parts of your body are affected and how long you’ve had your symptoms to determine whether your pain is acute (a temporary ache caused by a specific one-time event) or a chronic expression of an underlying condition. They may also ask you to move in certain ways to assess your range of motion.
If your doctor believes your pain is due to RA, they may also order imaging tests to see any bone, nerve, or spinal cord damage for themselves. Common tests include X-rays, magnetic resonance imaging (MRI), and ultrasound.
The treatments for back pain in people with RA depend on the severity of your symptoms and your unique health situation. A few pain management approaches are listed below. However, you should always talk to your doctor before attempting to manage your symptoms on your own.
Certain lifestyle changes may help reduce your pain and improve your long-term quality of life. These steps might include establishing a regular exercise routine, losing weight, and following an anti-inflammatory diet.
You can also engage in occupational therapy, which will teach you how to perform daily activities without straining your back, or physical therapy, which can help you strengthen your back muscles and extend your range of motion.
“I’m constantly stretching head to toe — swimming is my rehab,” one myRAteam member shared.
For immediate at-home pain relief, you may want to try hot and cold packs. Heat and cold therapy can provide a nonpharmacological way to manage symptoms during a flare-up. The pack you choose will depend on your symptoms. A hot pack can alleviate muscle spasms and improve blood flow, while cold packs can help reduce inflammation. For pain outside the cervical spine, hot packs will likely be the most helpful.
Several medications may be prescribed to treat back pain in people with RA.
Someone with mild aches may only need over-the-counter pain relievers, like aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), to help with back pain. Common NSAIDs include Advil (ibuprofen) and Aleve (naproxen). People with more moderate symptoms may be prescribed stronger oral NSAIDs to reduce swelling and pain.
For persistent pain in the spine, a doctor might suggest injecting corticosteroids or an anesthetic into an inflamed nerve section. These shots may provide near-immediate relief for weeks or months.
“I got a cortisone shot. It took the severity of the pain away and helped me be able to get around a little more without hurting so much,” one myRAteam member shared. “It really eased the pain to a bearable stage.”
Alternatively, your physician might recommend a disease-modifying antirheumatic drug (DMARD), such as methotrexate, to reduce your risk of flare-ups and minimize the damage caused during autoimmune attacks. These medications are helpful for inflammatory arthritis, so they may not be helpful for back pain in the middle or lower back, where inflammatory arthritis does not occur.
Your doctor may recommend surgical intervention to address your back pain after rheumatoid arthritis has caused damage to the cervical spine.
Spinal fusion is one of the most common procedures recommended to those with RA-related back pain. During a fusion, a surgeon will remove the affected joint and fuse the adjacent vertebrae with metal rods, screws, or a bone graft. Although this procedure decreases a person’s range of motion, it can help delay or prevent RA from progressing further into the spine.
Generally speaking, surgery is one of the last options a doctor will pursue when addressing back pain. You will need to work with your care provider to see which treatment route is best for you.
Rheumatoid arthritis poses a unique set of day-to-day challenges. Sometimes, it can be difficult to convey the daily realities to a person who doesn’t share your diagnosis. With myRAteam, you can connect with people who truly understand what it’s like to live with rheumatoid arthritis.
On myRAteam, the social network designed to support, validate, and empower people with RA, more than 151,000 members ask questions, share anecdotes, and befriend others who know what it’s like to live with RA.
Do you have something to add to the conversation around RA back pain? Share your experiences in the comments below or by posting on myRAteam.