Diseases and Conditions When to see a rheumatologist

What is autoimmune back pain?

December 26, 2016

Let’s face it, back pain is terrible and unfortunately for us, very common. According to the 2016 Global Burden of Disease Study, low back pain is the number one cause for disability globally.

So we know back pain is common and debilitating, but the question is, what is the difference between regular and autoimmune back pain?

There are two broad categories: mechanical back pain and inflammatory or autoimmune back pain. Many but not all autoimmune diseases cause back pain. For example, rheumatoid arthritis usually does not cause back pain. Sometimes these disease are very difficult to diagnosis because they progress very slowly. Often times it takes years to decades to diagnose. Yes you heard me, DECADES. Unfortunately, if left untreated, it can cause irreversible spinal damage: joint erosions and spinal fusion also known as ankylosis. Prompt treatment with a disease modifying anti-rheumatic agent (DMARD) often can slowdown or prevent joint damage.

Autoimmune back pain

As I was mentioning before, mechanical and autoimmune back pain are completely different. Mechanical back usually improves with rest, worsens with strenuous activity, and usually begins later in life. People that have autoimmune back pain experience the opposite. Here are some of the key features.

Usually pain starts during the 2^nd or 3^rd decade of life. People usually experience symptoms before the age of 45
Onset is gradual for the most part
Symptoms have been ongoing for more than 3 months
Exercise improves the pain
Rest really doesn’t help. The pain usually worsens with rest
Anti-inflammatory medications like naproxen or ibuprofen helps the pain
Pain wakes you up during the second half of the night
Pain and prolonged stiffness in the morning. Typically, stiffness lasts more than one hour
Alternating deep buttock pain

Risk factors

Autoimmune disease rarely occur in isolation. The following are some of the risk factors pointing towards a diagnosis of autoimmune back pain.

Personal history of uveitis. This is a type of inflammatory condition that affects the eye.
A personal history of psoriasis.
Having a history of dactylitis in your finger or your toes, aka “sausage digitis”.
History of inflammatory arthritis: redness, swelling, and stiffness in any joint
Any first degree relative with any spondyloarthritis (SpA)-associated condition? This means mom, dad, siblings, or your children. SpA-associated conditions include:
- Axial spondylitis also known as ankylosing spondylitis
- Psoriasis
- Psoriatic arthritis
- Reactive arthritis
- Crohn’s disease
- Ulcerative colitis

If you think you could be suffering from autoimmune back pain, please seek your local rheumatologist. But do not jump to conclusions. There are many other diseases that can mimic inflammatory back pain that are not autoimmune in nature.

References

Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602.

Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun; Suppl 2:ii1-44.

http://www.asas-group.org/publications/ASAS-handbook.pdf

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Diseases and Conditions When to see a rheumatologist

Signs you may be suffering from autoimmune joint pain

December 5, 2016

Pretty much everyone at some point in their lives is going to experience some form of joint pain. But when does joint pain become more than just your typical, “I over did it” joint pain? When does it become, “I think there is something really wrong” type of joint pain? Is this joint pain caused by an autoimmune disease?

Here are a few typical scenarios.

Scenario #1

Mr. B is a 65-year-old man who presents to clinic with bilateral knee pain. He first noticed the pain a few years ago. He used to take some over-the-counter ibuprofen when it got real bad and that used to relieve the pain. Over the past few months he has noticed worsening. His left knee sometimes swells up. The ibuprofen isn’t really cutting it anymore. He tells me that the pain is worse after particularly active days. When he sits down he feels pretty good but when he stands up, he feels pretty stiff but generally loosens up after a few steps. He used to work construction and played football in college.

Scenario #2

Mrs. M is a 53-year-old woman who comes to the clinic for joint pain. About 3 months ago, she noticed that she was having a lot of difficulty removing her rings. She really didn’t pay much attention to it. She told herself, “I must be eating too much salt”, “I must be getting old”. Over the course of the next few weeks she began developing pain and swelling involving her knuckles. The pain is particularly worse first thing in the morning and sometimes wakes her up in the middle of night at times. She also states, “My hands feel like a claw in the morning”. The stiffness last well over one hour in the morning and typically, by noon she’s as good as she is going to be for the rest of the day. She’s tried ibuprofen, naproxen, and acetaminophen but nothing seems to work. She also remarks that her hot flashes have gone completely out of control recently.

Sounds familiar?

Inflammatory vs. Non-inflammatory joint pain

In scenario #1, we have a man presenting with non-inflammatory joint pain. This is your common wear and tear arthritis or osteoarthritis. It can involve pretty much any joint you can think of. What is important to note, is that it tends to progress slowly over time. The joint pain tends to worsen with increasing activity and it typically responds, although maybe not completely, to over-the-counter anti-inflammatory medications. Usually there is no joint swelling, but when it comes to the knees, swelling often does occur. A phenomenon called “gelling” can also occur with osteoarthritis. This occurs when the joint has been in a resting position for a while and then becomes active. The joint stiffens up or gels, but then loosens up pretty quickly.

In scenario #2, we have a woman presenting with joint pain that develops over the course of 3 months, or what we call a subacute presentation. She’s experiencing joint swelling involving small joints and it’s associated with prolonged morning stiffness. What I mean by prolonged is over one hour. Her symptoms also are worse in the morning. She also experiences constitutional symptoms, i.e., hot flashes. These are all hallmarks of inflammatory joint pain. There are MANY different autoimmune diseases that present with inflammatory joint pain and they all have their own particular flavor. Some like the knuckles, some like the ankles, some like the knees, some have a symmetrical distribution, and some are simply just random. But they all share these specific key characteristics. Rheumatoid arthritis and psoriatic arthritis are two common types. Please follow the links to learn more about these.

Another important note about autoimmune joint pain. It doesn’t go away. This is very important. There are A LOT of different things that can cause a joint to swell, but most of them get better with time. When it doesn’t, then you have to start wondering.

Summary

Why is this important?

So why should you care? Well, first, walking around with swollen joints isn’t exactly the most pleasant thing in the world. It turns out that it isn’t exactly healthy for your joints either. Autoimmune joint disease at times can cause permanent joint damage and it can happen in as little as 3 months.