THE CLINIC: Dealing with Degenerative Arthritis

Wed, 12 June 2013 - 1:38 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I have the form of arthritis known as DISH—diffuse idiopathic skeletal hyperostosis.

Before I went to PT, I could sleep one hour in a bed, then move to a recliner when the pain got too bad, and then move from one to the other all night long. For the last three nights I have needed no pain medicine and I slept all night in a bed. I now go to PT twice a week and do stretching exercises. 

 

I do have narrowing of the cervical canal, excess bone build up in the spine, bone spurs, and wearing down of the spinal discs. I also have decreased space between the vertebrae. The cervical disc disease also makes me prone to herniated disks.

 

Can I avoid surgery? I know this is related to how well I can tolerate the symptoms. So far I have experienced no weakness. Also, I was wondering if this condition cause headaches. I think that would be logical as you end up with lots of tension in your neck. 

Jake Benvenuti

Margate, NJ

 

ANSWER:

Sounds like you're on the right track. Unfortunately, any of the conditions you mentioned can be associated with headaches. The narrowing in the cervical area is known as cervical stenosis. It is “thoracic” if it occurs in the middle back and “lumbar” in the lower back area. DISH is not really the build-up of bone in the spinal canal. The hallmark of DISH is ossification occurring along the anterior aspect of the vertebral bodies but remaining separate from the vertebrae. It usually involves the anterior longitudinal ligament of the thoracic spine, although it can also affect the cervical and lumbar spine as well.

 

Although this does sometimes lead to herniated discs, it does not always happen. I agree that when considering surgery, the extent of your symptoms and your ability or willingness to tolerate them are the main considerations. Feeling great and being able to continue your daily life are what are most important. Keep up the good work!

 

Mark McKeigue, DO

Orland Park, IL

 

 

ANSWER:

I am a physical medicine MD, which is a field specializing in providing non-surgical care to a variety of orthopedic conditions. A significant number of my patients are spine sufferers. I have a few DISH patients through the year, but cervical disc and spondylosis (spurs/arthritis) issues are more common. 

Our bones are born strong and the ligaments holding them together are strong and elastic. We have cushioning discs between the vertebrae in our spine. At birth, these discs have strong walls and are filled with a gelatinous type fluid which provides shock absorption. Traveling within the vertebrae, through continuous tunnel systems are nerves connecting the brain to the body. Our bone-to-bone connections (joints) have a continuous production of internal joint fluid to lubricate the joints. Periodic movements relieve the internal pressures on our joints, releasing some of this fluid.

 

As we age, gravity and lifting demands on our spine squeeze out the fluid in the discs, causing the bones to progressively lie closer to one another. There is less space between the bones for movement, and the rubbing of bones together produces spinal pain. The rubbing of bones against nerves causes arm pain, numbness, or weakness. The hyper-mobile walls of the discs or in the ligaments are another cause of spinal pain. In the end, our ligaments are loose, the discs are deflated, the bones are experiencing high frictional rubbing against one another, and in severe cases the crowding of structures around the nerve channels becomes stenotic and strictured. The bone/disc/ligament abnormalities are associated with neck pain and stiffness. Nerve irritation yields arm pains/numbness/weakness. Nerve injuries are often irreversible.

 

Treatment always emphasizes simple and inexpensive remedies at first, followed by more complicated, invasive, and expensive approaches. Surgery is at the end of the chain, and attempts to change the anatomical relationships of the above structures in patients with chronic unremitting pain levels, or in individuals who are experiencing nerve function loss.

 

Simple up-front treatments include:

 

Keep generally active, to "pump" out the joint fluid in our spine in a natural way. Repetitive low-impact exercise pushes out the joint fluid, and makes other activities that follow more tolerable. For this reason, swimming is at the core of all arthritis interventions. An arthritic joint produces joint fluid at an accelerated rate. An example of joint-fluid-related pain is that which can occur when barometric pressure drops before a thunderstorm.

 

Do avoid high impact, torsional loading to your spine. Activities which knock bone ends together, or which have high inherent shear forces will cause an increase and more rapid production of joint fluid, and redness. 

 

I do feel that periodic pain flares respond well to prednisone, a steroidal anti-inflammatory pill. It is usually prescribed for three to five days of treatment, and artificially but powerfully removes all forms of inflammation from your body. It will simultaneously remove joint fluid and swelling, and treat the inflamed nostrils and airways of asthma sufferers. Think of it as restoring your “factory default” joint settings. But the relief is temporary if joint arthritis is severe, or if there is not some follow-up mechanism like swimming. 

 

Surgery is attempted only if you have intolerable neck pains or if nerve injury evolves. And generally, surgery can only be performed if the injury or arthritis is confined to a small or modest area. For example, surgeons have little success when three to four discs are degenerated. 

 

If no surgery were performed on individuals with disc degeneration, where bones are rubbing painfully against one another, the biologic drive within our body is to grow bone spurs from one bone to another, bridging the gap. In time, the adjacent bones will fuse together, eliminating altogether the painful joint. 

 

If you have DISH, I would be surprised since it is defined by an abnormally accelerated process of spur formation all along the spine at multiple levels. These patients are very stiff from neck to bottom. I would suspect that the spur formation in your neck is more probably just at the levels of disc injury/degeneration, and in time these spurs can and often do fuse together. If you can't stand the pain, then surgeons can speed this process along by stimulating your body to fuse the painful neck joint levels quicker, and can implant a plate and screw system to reduce the joint motion significantly.

 

John Schnell, MD

 

Cleveland, OH

 

 

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Clinic pieces are edited and details are changed. In some cases pieces represent composites from several queries to, and answers from, the Clinic Advisory Board.

 

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.


(RUNNING & FITNEWS® January / February 2012 • Volume 30, Number 1)




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