Arthritis and spine injuries: People are often confused about the differences between various types of arthritis, and cannot differentiate between pain induced by arthritis and spine injuries. Arthritis refers to the inflammation (swelling) and tenderness of joints, describes conditions that affect joints, tissues around the joint, and other connective tissues, and is characterised by joint pain and stiffness, symptoms which worsen with age. There are more than 160 different types of arthritis which can be drug-induced, autoimmune, or occur due to infections, trauma, crystals, and malignancies.
Osteoarthritis and rheumatoid arthritis are the two most common types of arthritis, and there is often significant confusion about the differences between the two.
Differences between osteoarthritis and rheumatoid arthritis
Osteoarthritis, the most common type of arthritis, is a degenerative joint disease characterised by the breakdown of joint tissues over time, and chronic joint pain and stiffness, which make it difficult for the affected person to perform daily tasks. Osteoarthritis occurs when the cartilage lining the joints is damaged or worn down, as a result of which the bones rub together when one uses that joint. Cartilage is the hard, slippery tissue covering the ends of bones where they form a joint. In other words, in the case of osteoarthritis, the cartilage calling the bones in joints starts breaking down or wearing away.
Rheumatoid arthritis is an autoimmune and inflammatory disorder which affects the lining of joints, causing a painful swelling that can result in bone erosion and joint deformity. It occurs because the immune system mistakenly attacks healthy cells in the body, resulting in painful swelling in the affected regions of the body. Also, rheumatoid arthritis can affect body parts other than joints, according to Mayo Clinic. These include the skin, lungs, blood vessels, eyes, and heart.
Therefore, osteoarthritis results in wear-and-tear damage of joints by affecting the cartilage capping the ends of the joints, and rheumatoid arthritis affects the lining of joints.
Rheumatoid arthritis can affect multiple joints at the same time.
“Rheumatoid arthritis (RA) is an autoimmune disease that affects multiple joints (polyarthritis) symmetrically, causing joint swelling, pain, and deformities. Osteoarthritis (OA) is a degenerative joint disease primarily affecting one or more joints of the body, causing pain, stiffness and restricting activities of daily living,” Dr Samarth Arya, Consultant, Orthopaedics, Joint Replacement & Robotic Surgery, SPARSH Hospital, Bangalore, told ABP Live.
Rheumatoid arthritis and osteoarthritis can be differentiated from each other not only on the basis of symptoms, but also based on diagnostic tests, and the types of joints affected. While rheumatoid arthritis affects small joints symmetrically, osteoarthritis causes wear and tear of larger weight-bearing joints.
“Differentiating between rheumatoid arthritis (RA) and osteoarthritis (OA) requires taking into account symptoms, disease processes, and diagnostic tests. RA is an inflammatory illness characterised by joint inflammation that usually affects small joints symmetrically, whereas OA is a degenerative disorder that mostly affects larger weight-bearing joints owing to wear and tear. RA is diagnosed using blood tests such as rheumatoid factor and anti-CCP, whereas OA is validated using imaging that shows joint degradation,” Dr Yash Gulati, Senior Consultant, Orthopaedics, Joint Replacement & Spine, Indraprastha Apollo Hospitals, New Delhi, told ABP Live.
The presence of high levels of rheumatoid factors, which are proteins made by the immune system to attack healthy cells, can indicate an autoimmune disease such as rheumatoid arthritis. A rheumatoid factor test can be used to detect the presence of these proteins. Anti-cyclic citrullinated peptide test is a blood test used to detect the presence of an amino acid called citrulline, which is present in the body when one has rheumatoid arthritis.
How to differentiate between spinal cord injuries and spinal arthritis
One may also be unable to differentiate between the spine injuries occurring due to traffic accidents, sports-related injuries, medical malpractice, slip-and-fall conditions, acts of violence, and neurological disorders, and those occurring due to degenerative bone disease or arthritis.
Spinal cord injuries can lead to severe morbidity and permanent disability, and occur when the axons of nerves running through the spinal cord are disrupted, resulting in loss of motor and sensory function below the level of injury. Spinal cord injuries usually occur as a result of major trauma, and primary spinal cord injuries are often irreversible.
Spinal cord injuries include damage to any part of the spinal cord, or to the tight bundle of cells and nerves running down the spinal canal and sending signals from the brain to the rest of the body, and receiving signals from the body. The spinal cord, protected by the vertebral column, extends from the lower part of the brain down through the lower back.
The brain and spinal cord constitute the central nervous system (CNS), and when spinal cord injuries occur, coordination, balance, movements, and sensations are affected. As a result, the person with the spinal cord injury cannot effectively use their body below the level of injury. If a spinal cord injury is too severe, paralysis may occur.
When inflammation occurs in the sacroiliac joints, which are the joints linking the pelvis and the lower spine (sacrum), and facet joints, which are joints in the spine located in the posterior aspect of the spine, provide flexibility and stability to the spine, are hinge-like, and link the vertebrae together, the condition is known as spinal arthritis, or arthritis in the back or neck. Spinal arthritis may occur due to wear and tear of these joints, autoimmune disorders, or infection. The condition may also affect regions where ligaments and tendons are attached to the bones of the spine. Osteoarthritis can affect the spine by wearing down the cartilage capping the ends of joints.
Rheumatoid arthritis of the spine can occur if rheumatoid factors attack the synovium, or the lining of joints.
Spinal cord injuries can be diagnosed through magnetic resonance imaging (MRI), which shows the brain and spinal trauma from injury, vascular irregularities in the spine, bleeding and inflammation that might compress the spine, herniated discs or problems with the cartilage located between the vertebrae, and injuries to the ligaments supporting the cervical spine, among others. Computerised tomography, which detects bone fractures, bleeding, and spinal stenosis, or narrowing of the spinal canal, and X-rays, which can detect misalignment of the vertebrae, and fractures within minutes of injury, are also used to diagnose spinal cord injuries.
Spinal arthritis can be diagnosed by tracking one’s medical history, conducting blood tests to detect genetic markers and autoantibodies which indicate the occurrence of rheumatoid arthritis of the spine, X-rays of the spine to spot the location of the arthritic joint, MRI, CT scan, bone scan, and ultrasound to check if there is nerve damage, and joint aspiration, which is the process of testing the synovial fluid inside a joint, according to Johns Hopkins Medicine. The reason why certain scanning tests are used to check if nerves are damaged or not is that if nerves are not damaged, then the medical practitioner will be sure of the fact that the inflammation in the spine is not due to a spinal cord injury, but due to spinal arthritis.
Therefore, back pain occurring due to spinal cord injuries is associated with neurological symptoms, while arthritis-related back pain, also known as spondylosis, is associated with damage to the joints of the spine. Spondylosis may not affect the nerves, but if there is direct pressure on the nerve roots of the spinal cord, the spinal nerves may be affected.
“Back pain due to spinal cord involvement often involves neurological symptoms like numbness or weakness, while arthritis-related back (spondylosis) might spare the nerves unless it reaches a stage where there is direct pressure on the nerve roots of the spinal cord. Diagnoses involve detailed history taking, clinical assessment, imaging, and blood tests to distinguish the causative pathology,” said Dr Arya.
What other diseases does arthritis lead to?
Arthritis can lead to several other diseases. For instance, rheumatoid arthritis increases the risk for developing chronic diseases such as heart disease and diabetes. Therefore, to prevent heart disease and diabetes in people with rheumatoid arthritis, they must take precautions to reduce the risk factors for those diseases. Rheumatoid arthritis can also increase the risk of inflammation and scarring of lung tissues, resulting in progressive shortness of breath, according to Mayo Clinic. It is also associated with an increased risk for lymphoma, which is a group of blood cancers developing in the lymphatic system.
Apart from lung disease, diabetes, and cardiovascular disease, arthritis affects the quality of people’s life due to pain and immobility, and leads to problems such as depression, anxiety, sleep, and fatigue.
“Arthritis does not cause other diseases, however it is connected with a variety of comorbidities and concomitant ailments,” said Dr Gulati. A concomitant illness is one which exists at the same time as another.
Arthritis also increases the risk of osteoporosis due to inactivity. Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality or structure of the bones change, leading to a decrease in bone strength. It is a silent disease because one typically does not have symptoms, and may not even know they have the disease, until they break a bone. The disease increases the risk of fractures.
“Rheumatoid arthritis, for example, has been related to an increased risk of infections, kidney illness, and lung issues. It is critical to recognise that these problems are not universal, as their likelihood varies depending on the kind and severity of arthritis. Proper medical treatment, lifestyle changes, and medication can help manage arthritis and lower the risk of other health problems. Regular visits to a healthcare provider are essential for monitoring and resolving these issues,” Dr Gulati concluded.
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