
	Medical Edge


	About

	Television

	Radio

	Newspaper

		Participating Newspapers

	Magazine

	Contact


	About Mayo Clinic

	Make an Appointment at Mayo Clinic

Medical Edge Newspaper Column from Mayo Clinic

SOME TREATMENT OPTIONS FOR SPINAL ARTHRITIS

DEAR MAYO CLINIC: What are the latest treatments for spinal arthritis? — Canada

ANSWER: Spinal arthritis is a general term that includes osteoarthritis and several types of inflammatory arthritis.

The most common type of arthritis affecting the spine is osteoarthritis, which, strictly speaking, affects the facet joints of the spine. The facet joints are paired structures at all levels of the cervical, thoracic, and lumbar spine that help to promote and limit bending and twisting movements.

Osteoarthritis is commonly accompanied by degenerative disk disease and termed “spondylosis.” These conditions are nearly universal accompaniments of aging and can cause spine pain and stiffness. While there is no cure, you and your doctor can devise a treatment plan to reduce pain and maintain mobility. Options include activity modification, various forms of physical therapy and, if needed, medications.

Medication options for osteoarthritis include acetaminophen and over-the-counter and prescription nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and others. Stronger prescription analgesics can also be used.

If a disk ruptures and compresses a nerve root or the spinal cord, or if osteoarthritis narrows the spinal canal, surgery may be considered to decompress the nerve root or spinal cord. For degenerative disk disease, fusion of one or more adjacent intervertebral bodies has been performed for many years using bone and metal hardware. A new surgical option is to replace the damaged disk with an artificial one. This October, the U.S. Food and Drug Administration approved an artificial disk for use in the lumbar spine.

Ankylosing spondylitis is a chronic inflammatory arthritis that affects chiefly the joints and adjacent tissues in the spine, resulting in spine pain and stiffness. Psoriasis and inflammatory bowel disease can also be associated with an inflammatory arthritis that affects the spine.

For inflammatory arthritis of the spine, first-line treatments include activity modification and physical therapies. Nonsteroidal anti-inflammatory drugs can be helpful. Some patients with psoriatic or inflammatory bowel disease-associated inflammatory arthritis may respond to sulfasalazine (Azulfidine), a disease-modifying antirheumatic drug, or DMARD. For more severe cases of inflammatory arthritis, we use methotrexate (Rheumatrex), also a DMARD.

More recently, tumor necrosis factor blockers have been found to decrease inflammation and pain. Examples are etanercept (Enbrel) and infliximab (Remicade).
The goals of treatment are to reduce pain and stiffness, delay or prevent complications, and prevent disability.

— Harvinder Luthra, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Spinal Arthritis (Osteoarthritis)
Appointment Information
More Information on Osteoarthritis

READERS: Physicians and researchers have known for years that there is a difference in immunity between men and women — but they have not known why.

Now, new research in animals suggests one possible mechanism driving the difference: The presence of testosterone slows or weakens the response of the immune system’s T-lymphocytes—the “attack cells” responsible for destroying invading pathogens. The report appears in the Nov. 15 edition of the Journal of Immunology.

These findings suggest that therapeutically manipulating testosterone levels may one day provide an approach to bolster the host’s immune system to treat AIDS, or to help cancer patients who will receive immunotherapy or who are rendered vulnerable to infection because of chemotherapy.

Additional Resources:
Difference in Immunity between Men and Woman

- - -

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.