FAQs on Arthritis Treatment in Nashville

Arthritis – Extremities & Spine

Arthritis is a common problem that affects the weight-bearing joints of the legs, as well as the spine. Arthritis of the lumbar spine occurs in the facet joints, which connect each vertebra (bony spinal segment). Along with the spinal discs, the facet joints allow spinal movement and stability. When arthritis occurs in the spine, it is referred to as spondylosis.

How common is osteoarthritis?

The most common form of arthritis is osteoarthritis (OA), which is a wear and tear condition. OA affects as many as 14% of the U.S. adult population—an estimated 27 million Americans.

Who is affected by arthritis?

Patients who are at the greatest risk for developing arthritis include:

  • Heavy laborers
  • Obese individuals
  • Older patients
  • Those with joint or spine injuries

What conditions occur along with spinal arthritis?

Spinal arthritis is often seen along with other conditions, such as:

  • Spinal stenosis – With the arthritis process, the nerves of the spine become compressed (pinched), leading to symptoms of leg pain, tingling, numbness, and difficulty walking.
  • Degenerative disc disease (DDD) – The intervertebral discs lose water content and stiffen with age and wear. This results in loss of ability to cushion the bony vertebrae of the spine.

What are the symptoms of arthritis?

Arthritis of the joints causes stiffness, pain, loss of mobility, and swelling. Patients with spinal arthritis complain of pain, stiffness, and decreased flexibility. The stiffness is worse early in the morning, upon rising, but it often improves over the course of the day. Most patients report that symptoms are worse after strenuous or prolonged activity.

What is the treatment for arthritis?

The treatment of arthritis depends on the symptoms and the site of the diseased joints. Some treatment options include:

  • Physical therapy – Used to strengthen muscles, improve flexibility, and increase mobility, physical therapy is often ordered for patients with spinal arthritis and joint problems. Ice and heat applications are often used along with spinal decompression therapy.
  • Medication – Tylenol (acetaminophen) is the drug of choice for arthritis pain. In addition, nonsteroidal anti-inflammatory medications are used to decrease inflammation around arthritis joints.
  • Epidural steroid injection (ESI) – The epidural is a layer that lies outside the spinal cord. With the ESI procedure, the doctor administers a potent steroid medication into the epidural space, which is between the spinal cord and the epidural layer. According to numerous clinical studies, the success rate of ESI is 80-90%, with symptom relief lasting up to three months.
  • Facet joint injection (FJI) – Using fluoroscopy (x-ray guidance), the doctor numbs the back using a tiny needle and a local anesthetic before positioning needles into the affected facet joints of the spine. A corticosteroid medication and anesthetic agent are injected onto the nerves. In recent studies, the success rate of FJI was reported at 84%, with patients reporting both pain relief and functional improvement.
  • Hyaluronic acid joint injections – Developed only for knee OA, hyaluronic acid injections are used to replace lost synovial joint fluid, which lubricates and absorbs shock. Orthovisc is given each week for approximately 3-4 weeks, whereas Synvisc-One is a long-acting injection given less frequently. The doctor injects the medication directly into the joint space, using sterile technique. In a recent study of more than 4,500 patients with knee arthritis, the injection of hyaluronic acid significantly improved functional ability and relieved pain.
  • Cortisone joint injection – Steroids are anti-inflammatory agents, used to reduce joint inflammation and improve pain as well as mobility. This injection is used for short-term relief of OA, and can be administered into any body joint. The doctor often uses ultrasound guidance to ensure needle placement before instilling the medication into the joint space. According to a large review of studies, intra-articular steroid injections were found to be more effective than placebo, with effects lasting up to 24 weeks. In once clinical study, the success rate was 80% for knee injections.

Resources

Bellamy N, Campbell J, Robinson V et al. (2006). Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev, 19: CD005328

Chumacher HR & Chen LX (2005). Injectable corticosteroids in treatment of arthritis of the knee. American Journal Medicine, 118(11), 1208–1214.

Kim D & Brown J (2011). Efficacy and safety of lumbar epidural dexamethasone versus methylprednisolone in the treatment of lumbar radiculopathy: a comparison of soluble versus particulate steroids. Clin J Pain, 27(6), 518-522.

Lawrence RC, Felson DT, Helmick CG, et al. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum, 58(1), 26-35.

Manchikanti L, Singh V, Falco FJ, Cash KA, & Pampati V (2008). Effectiveness of thoracic medial branch blocks in managing chronic pain: a preliminary report of a randomized, double-blind controlled trial. Pain Physician, 11(4):491-504

Miller LE & Block JE (2013). US-approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: Systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis Mus Disorders, 6, 57-63. doi:  10.4137/CMAMD.S12743

Sacks JJ, Luo Y-H, & Helmick CG (2010). Prevalence of specific types of arthritis and other rheumatic conditions in the ambulatory health care system in the United States, 2001–2005.  Arthritis Care & Research, 62 (4):460-464.