Back pain and rheumatic disease 4.36/5 (14)

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Back pain

Different rheumatic diseases cause back pain

Definition

The spine includes Neck vertebrae (cervical), Thoracic og Lumbar spine. Acute back pain begins suddenly or during hours-days. Chronic pain has a duration of at least 3 months. You can also split back pain into three main groups:

  1. Non-specific back pain (80-90%) corresponding to lumbago where no underlying disease is detected
  2. Nerve root pain, often caused by prolapse of the intervertebral disc with subsequent sciatica or spinal stenosis
  3. Specific back pain in which the underlying disease is detected There is in this group a finding of rheumatic disease that can cause back pain

Ten rheumatic diseases that can cause back pain

  1. Osteoarthritis in the back
    1. Spondylosis er Osteoarthrtitis between the vertebrae. X-rays show osteophytes.
    2. Osteoarthritis of the side joints in the back (facet joints). Pain from the side joints (facet joints) in the back is believed to be a common cause of back pain. Most localized pain on one side. The disease mechanism is poorly explained
  2. Osteoporosis (Osteoporosis). Rapid onset after injury may be compression fracture with compression of vertebra, often by osteoporosis. The pain often lasts for 2-3 months
  3. DISH (Diffuse idiopathic skeletal hyperostosis) causes gradual stiffening of the spine due to continuous calcification, gradually with the development of osteophytes
  4. Fibromyalgia causes chronic pain throughout the body, most often among women
  5. Inflammatory back pain (Persons under 40 years, gradual start, duration of at least 3 months, better by activity) may be the start of Ankylosing spondylitis or other spondyloarthritis
  6. Muscles (myalgia). Tension in the neck often causes pain and stiffness with headache (stress headache). Pain in the neck, lumbar spine and pelvic pain may be localized muscle pain or part of more extensive pain as in Fibromyalgia
  7. Polymyalgia rheumatica causes new pain and stiffness in the pelvis, thighs, shoulders and upper arms of people over 50 years. Blood tests show high inflammation tests (CRP, Sedimentation rate)
  8. Retroperitoneal fibrosis / IgG4 related disease
  9. Spinal stenosis causes chronic pain, most often in the elderly in the lower back. Reliefed by forward bending (flexion)
  10. Spondylarthritis
    1. Ankylosing spondylitis occurs gradually and usually between 20 and 45's age. X-ray, CT or MRI images show arthritis i sacroiliac joints og syndesmophytes in the spine
    2. Psoriatic arthritis

Other specific disease causes

Nerves / Sciatica (Nerve root Pain)

Sciatica

The sciatic nerve is colored yellow. Wikimedia commons Own work, CC BY-SA 4.0

Symptoms

  • Prickly intense, "lightening" or "electric" pain that radiates most often to one leg, less often to one arm or head

Disease Cause

Symptoms 

  • Radiation to leg is called sciatica or sciatica and can originate from the lower back
  • When radiating to the arm or head, the cause can stem from the neck
  •  Most (90%) become symptom-free or almost symptom-free during 3 months. Some have to be operated quickly because of nerve damage or unbearable pain
  • Please see the table "Nerve compression" below

Muscle pain, LumbagoNonspecific back pain)

Acute muscular pain (Crick in the neck, lumbago in lumbar spine)

  • Typically occurs after an unfortunate movement. The pain does not radiate in the arms or legs
  • No special underlying disease exists
  • Compose 80-90% of cases of back pain
  • The pain progresses gradually over a few days-weeks
  • It is recommended to resume normal physical activity as soon as possible
Back pain and rheumatic disease

Blausen.com staff (2014)CC BY 3.0 via Wikimedia Commons

Pregnancy

Medical examination for back pain and rheumatic disease

Disease history

Localization

  • Sore or tight muscles may be secondary due to pain
  • Exposure to areas of the skin (dermatom) may indicate nerve affected, for example at prolapse
  • In case of suspected nerve manifestation (prolapse), the following table may be useful

Table: Nerve compression / Nerve pain from the lower back

Nerve root Common location Test Sensibility Reflexes
L4 L3-L4 Knee stretch. Ankle-suppinasjon Thigh-front. Shin-inside (medial) Patellar (knee)
L5 L4 / L5 Ankle dorsiflexion. Toe extension. Laseques test (30-70 degrees). Heel-walk Thigh and lower sides. Foot-dorsally
S1 L5 / S1 Ankle plantar flexion. Toe-walking Heel and malleol lateral Achilles
Cauda equina Sphinx ani Urinary bladder and rectum palsy

Pelvic Pain

Many possible reasons

Red flags

Warning symptoms "Red Flag" which indicates investigations for surgery within a few hours

Other signs that are symptoms of other back pain suggest that the back should be thoroughly examined

  • New back pain in people under 20 years or over the age of 50
  • Constant pain for several weeks
  • Also pains at rest
  • General disease sensation (beyond pain)
  • Weight Loss
  • Previous accident
  • Known cancer disease
  • Increasing paralysis or other neurological outcomes
  • Deformity in the back
  • Clear stiffness in the back in the morning with duration for over an hour (inflammatory back pain)

Treatment and follow-up

Literature


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