Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are two forms of arthritis that can affect the spine. In this review article, Dr. Borenstein from the George Washington University Medical Center explains how these two conditions are different. Major improvements in treatment are discussed for each form of arthritis.
Both AS and RA are inflammatory forms of arthritis. Both affect the spine although RA is more likely to cause problems in the cervical spine (neck). AS affects the spine from the neck all the way down to the sacroiliac joints and sacrum.
The inflammatory process is similar but the effects are very different. AS affects the entheses, the place where tendons and muscles attach to the bone. Inflammation leads to calcification and stiffening of the soft tissues. The bones start to fuse together. Pain and limited motion are the result.
RA affects the synovial and cartilage linings of the joint including the top layer of bone. The joints become weak and unstable. They can even sublux or partially dislocate. Patients with RA of the cervical spine are at risk for damage to the spinal cord or pressure on the nerve roots.
Treatment for both conditions has improved with the discovery of disease modifying drugs. These medications called tumor necrosis factor (TNF) inhibitors stop the soft tissue changes and joint destruction. Pain can be controlled. Patients are able to maintain function. Details of what these drugs are and how they work are presented.
Surgical treatment is an option for patients with severe deformities or who don’t get better with medical treatment. Spinal surgery to correct deformities and/or spinal fusion are possible for patients with AS. Patients who have RA and develop vertebral subluxations may need a fusion to stabilize the spine and prevent neurologic problems.