Consider OA, PsA, and AS for lower back.....or a combination.

Hi Oceans11,
I have had lower back problems since 1996. I had terrible spasms and pain for 13 months back in 1996. My MRI was negative. That may have eased my mind some but after trying a couple chiropractors who never helped I found a real strong, confident chiropractor who was able to adjust that area. A few treatments with him and I felt so much better. Fast forward to 2007 when I was working outside, bent to grab something on the lawn and collapsed from a blast of pain that was so great I couldn't walk. After laying on the lawn for a while a neighbor helped me up to the house. An MRi showed a slightly herniated disc but the surgeon said that there was still a gap between the disc and the spine so it should calm down after a while. It did but between that injury, the one in 1996 and another in 2001 I had terrible numbness in my legs every night and it began to disturb my sleep. I also still had flare ups of severe pain. My quality of life was declining so I called an orthopedic group and was lucky enough to be placed with a physiatrist who got me Tens unit, got me to a PT who trained me on some exercises and was given a conservative prescription of Vicodin, a more liberal prescription of Tramadol, muscle relaxers and most importantly the NSAID Lodine which I had used in the past. The stretches and the long term treatment of Lodine calmed the sciatica down and diminished my pain.
I had a couple good years of pain free living before getting RA in 2014. My rheumatologist now treats my back issues as it is a form of osteoarthritis. Fortunately I'm still okay there. He will give me the Lodine but won't let me use it daily because I'm on a maintenance dose of prednisone. In fact he just wanted to give me muscle relaxers but I told them they didn't do much and begged for Lodine (etodolac) to use for sciatica. It still helps to this day. I use the lowest dose but at my last visit I slipped and said I took one Lodine daily. He would prefer I use it only on occasion but I plan to push the issue at my next visit because I like to take use Lodine for RA pain as well. Studies showed that the combination of s strong NSAID taken with a Tramadol provides about a much pain relief as a 5 mg Vicodin. I will admit that they do work pretty good together. Seeing my RA is far from being under control and the Lodine is fairly mild and my prednisone dose is low I'm going to keep pushing for the right to add Lodine to my regimen to keep the sciatica away and to relieve some RA inflammation. I should add my rheumy has me on Prevacid and I have zero GI issues.
Sorry for the long response. Now to answer your question about RA and the lower back I did have a major flare 13 months ago and I'm positive my sacroiliac was inflamed during this flare. That joint is lower than where I usually have back pain and I was quite uncomfortable until the flare broke. Sacroiliitis is common for those with psoriatic arthritis and though I am convinced I have RA I did have what appeared to be psoriasis clear up when I was on Enbrel. I have also gotten the sausage like fingers and toes common with psoriatic arthritis. There were a couple more clues but I have a positive RA factor and and symmetrical joint pain so if anything I'm one of those rare individuals with RA and PSA.
The sacroiliitis has not returned but I do still have lower back pain and I believe I'd have it regardless of my auto-immune diseases.

My rheum kept telling me that RA doesn't affect the lower back. It would have been more accurate to say that it doesn't affect the joints in the lower back. My orthopedist and pain management specialist both think that my chronic back pain, which is most severe in the lumbar region and flares along with all my other symptoms, is possible inflammation from RA and definitely tension secondary to RA pain. This was based on an x-ray and an exam, no MRI yet. There is also a good possibility that I'm dealing with PsA or, less likely, AS. When I find a new rheumatologist, I hope to figure it out. In the mean time, good NSAID's and muscle relaxers help.

FWIW, I've had intermittent back pain since I was a teenager. No accidents, and I was very fit. It has worsened over the years and about two years ago (the same time all of my other symptoms worsened) it became chronic. It has always been the worst, most severe and chronic pain that I have.

I should add to that imaging has revealed extensive tendinopathy elsewhere, which is part of the reason the pain mgmt. doc thinks tendons in my lower back may also be inflamed.

I have not experienced my back "going out" just hideous pain and stiffness.

In my experience so far, rheumatologists don't seem to believe that RA causes tendinopathy while other doctors think that's a no brainer. Science established the relationship between RA and tendinopathy in the 1960's.

@gryd1963

Thanks for you input. I'm glad you went into detal to be honest because people who tend to suffer from back pain have long stories about it because we live with it & pretty much cope with it until BAM!! Something just knocks us to our feet. So it was actually refreshing to see your journey. I wouldn't say mine is as extreme but when you talked about being in the yard & just going down to pick something up & it just completely took you out, isn't that weird? It's never about doign something weird or over the top. Mine went out just turning on the shower! LOL!

@etain11,

When I describe the sense of "going out" the only way i can describe it is it feels like something is poking my nerve & that poke to the nerve just shuts down everything from the waist down. It's more "shocking" than painful to be honest, but the pain is definitely there!

I do agree that although clinically RA supposedly doesn't affect the back, it does for sure affect yoru cervical region & your spine is like a domino. When one is affected the other parts of the spine, muscles etc will try to compensate. When we feel the pain, maybe we think it "originated" there but it could just be the end effects of the RA hitting someplace else.

It sucks. I never really took working out seriously as a young adult. But after the RA dx in my early 40's I finally began & never thought I'd end up liking "working out".

Oh well, times they do change I guess? LOL!

I have a lot of lower back pain. However, due to the RA, my hip has begun to degenerate. My rheumatologist believes that a lot of my lower back pain has to do more with that than an issue with my lower back directly.

i get pain confused between the tronch bursas (inflammed), the hips (ra), the L5 (herniated) and the S1 (shot to hell)

I do know that I am having a current temper tantrum and not allowing anymore steroid injections this year (usually about twice a year those deep need guided ones under anesthesia that make money for the pain management needle guy) they help - like too much - I am addicted to them. enough. since 2008 for those. i figure my joints must look like confectionary sugar.

sorry you have this challenge also - I go to PT a lot, stretch a lot and compensate to the extent able with my quads, hams and core.

depot

I have recently been having some of the same problems. I haven't had any back problems in my life except a torn muscle in my upper back in my 20's from heavy lifting. Now I am pushing 42 and recently had a lot of stiffness and pain in my lower back after waking up from bed one morning. I just thought I had slept funny on the couch that night. I kept giving it time to work itself out but it never did. After about 6 weeks of this junk I finally decided to see my pcp. My doc took an xray and couldn't find anything wrong that might be causing the trouble. I opted for a steroid injection to the hip and by the next day it was already feeling a little better. After a week later I was feeling about 95%. A month later now and I'm still not completely better but it's very tolerable and not giving me much trouble at all. My doc seemed to think it is probably connected to my ra. I'm gonna run it by my rheumy in July at my next appointment and see what he says about it. I have been thinking about joining the gym and was just wondering how lifting weights affects your ra? I do a lot of lifting and stay active at work and it doesn't seem to affect my ra much. Sometimes hard work feels like it makes my symptoms worse and sometimes I will feel like it has done me some good. Hope you get back to normal soon. Not much worse than back pain as it can put you down, out, and frustrated beyond belief when it affects your daily activities. Good luck!

@depotblue & PW39,

Hey guys,

Yeah both of you guys mentioned injections & my Ortho suggested if I get worse then I should consider it. Since my deductible is already paid up since taking the lower lumbar MRI it would probably be a good idea to think about before I have to re-invest into my deductible again!

So his procedure is an epidural then a cortizone injection right at the site of the bulge. I know cortizone shots basically shrink any tissue that's inflammed & I know it works well. I had a small keloid on my chest one time & they injected coritzone into that & it was gone within 2 weeks! Amazing! So I'm rather excited about this procedure. My boss had it & said he felt like a kid again but it only last 2 years until he re-injured himself & this time it was 10 times worse?

Anyway, yes I"m doing the PT, all the weird stretches & core excercises to get my core strengthened. Last time I was at PT I was good to go within 4-6 weeks. I'm already at that time frame & I wouldn't go back to any heavy lifting at this point so we'll see in the next 2-4 weeks how I am.

Thanks for all the input!

the pain needle sticker md's love these because they tell me in their monkey jump fluoroscopy suits that most of their patients get immediate relief.

you are going to get a different answer for every poster about duration.

no way 2 years for me.

more like 3 months but i only get back stuck twice a year. and this is for years and years and years. that's why I am starting to balk. i figure the crap that is cortisone is starting to disintegrate, me.

but you are a newbie pin cushion - so i wish you all the best

depot

@depotblue

Newbie pin cushion!! BAAAHAHAHAAHAA!!!

Thanks, I'll definitely keep it in mind not to get TOO used to it, if I decide to go that routte.

Have been following this forum for years but this is my first post. I was really suffering with back pain to the point I had a great deal of difficulty walking. Xray showed some OA and slightly bulging discs. Tried PT but was unable to do it due to the pain. MRI showed inflammation of the facet joints from L4 to S1. Was referred to a pain specialist. After months of diagnostic tests I finally had RFA (radio frequency ablations) and had instant unbelievable relief. The relief lasted 9 months and I am awaiting an appt. to have it redone. The improvement in my quality of life is well worth it.