Rheumatoid arthritis contributing to lumbar spinal stenosis. Neurogenic intermittent claudication

Treatment of gouty lumbar spinal stenosis: a case report and bioinformatics analysis

The case of Lumbar spinal stenosis (LSS) combined with tophi due to gout is rarely reported. In the course of our clinic work, we encountered a young male patient who was diagnosed with a history of gout for 5 years and was targeted as LSS combined with gouty tophi, and we would like to share this case. In addition, in order to further investigate the deep mechanism of LSS associated with gout, we obtained the intersecting genes of the two diseases based on a machine learning approach by obtaining the dataset GSE113212 related to LSS from the Gene Expression Omnibus (GEO) database, and the genes related to gout from the human gene database. We found that TGFB1, PPARG, and SAMRCC1 may be important biomarkers for treating of both diseases. From a clinical perspective, clinicians should be vigilant about the possibility of gouty lumbar spinal stenosis with tophi in young patients presenting with back pain, hyperuricemia, and elevated inflammatory markers. A combined surgical and pharmacological treatment plan has a favorable prognosis. Investigating the mechanisms of action of core genes may provide new insights for treatment, ultimately leading to the development of comprehensive and personalized diagnostic and therapeutic strategies.

Spread of spinal block in patients with rheumatoid arthritis

BACKGROUND

In clinical practice, we noticed a greater than expected spread of sensory spinal block in patients with rheumatoid arthritis. We decided to test this impression and compared the spread of standard spinal anaesthesia in rheumatoid and non-rheumatoid control patients.

METHODS

Spinal anaesthesia with 3.4 ml (17 mg) of plain bupivacaine was administered to 50 patients with seropositive rheumatioid arthritis and to 50 non-rheumatoid control patients. The protocol was standardised for all patients. All the patients were undergoing lower limb surgery and the rheumatoid patients were operated on due to their rheumatoid disease. The spread of sensory block was recorded 30 min from the dural puncture using a pin prick test and a cold ice-filled container. The impact of body mass index (BMI), height and age on the spread were analysed.

RESULTS

The spread of sensory block was greater in patients with rheumatoid arthritis (15.6+/-3.1 dermatomes) than in non-rheumatoid patients (14.1+/-3.3 dermatomes) (P<0.05). Increasing BMI was related to cephalad spread of block in the rheumatoid group (P<0.05), but not in the control group.

CONCLUSION

The mean spread of sensory block 30 min after the injection of plain bupivacaine was 1.5 segments cephalad in patients with rheumatoid arthritis than in those without this disease. BMI might be a patient-related factor contributing to the extent of the block in rheumatoid patients. These findings should be considered when performing a spinal block in rheumatoid patients.

Affektionen der Lendenwirbelsäule bei rheumatoider Arthritis

In rheumatoid arthritis the anatomical structures of the lumbar spine are affected by the same mechanisms of destruction as are known from other skeletal regions. Although spinal symptoms do not become apparent until the later stages of rheumatoid arthritis, patients do sometimes complain of typical symptoms. We present data recorded in 19 patients with seropositive rheumatoid arthritis who underwent hospital treatment directed exclusively at isolated low-back pain. The patients were questioned in some detail with the aid of instruments including the Oswestry, TypE, HAQ and RADAI questionnaires and a visual-analogue-pain scale. Roentgen exposures were also evaluated. A comparison was drawn between patients treated surgically with decompression and various spondylodeses (n=13) and those who received conservative treatment (n=6). Better results were obtained in the group of patients treated surgically, though a statistical evaluation was not possible. No histological evidence of rheumatoid alterations was found in the intervertebral disc tissue samples available.

Upper thoracic myelopathy caused by vertebral collapse and subluxation in rheumatoid arthritis: report of two cases

We report two cases of rheumatoid arthritis (RA) with upper thoracic myelopathy and a review of the literature. Clinical data of a 47-year-old woman (case 1) and a 54-year-old woman (case 2) are described. Case 1 showed a transverse-type myelopathy at the T2 segment level of the spinal cord and case 2 had the same type of myelopathy at the T4 segment level. Case 1 had anterior vertebral subluxation of C7 due to marked vertebral collapse and Case 2 had subluxation of T2 with vertebral destruction. These two patients had the mutilating type of RA with multilevel spontaneous fusion in the cervical spine. The lesions in the thoracic spine might be caused by the severe destructive inflammation that is characteristic in mutilating disease. The vertebral collapse might lead to subluxation of the upper thoracic vertebra, resulting in spinal cord compression. Upper thoracic subluxation might be caused by vertebral collapse due to RA and the increased motion as a compensation for decreased mobility caused by spontaneous fusion in the cervical spine.

Surgical treatment of lumbar stenosis: long-term results

Lumbar stenosis is a disease of the elderly which is due, in the majority of cases, to degenerative changes. This disease causes considerable disability which cannot be ameliorated well by conservative treatment. Surgery is usually the treatment of choice, although long-term results have been reported in only a few publications. We attempted a reevaluation of our patients one to seven years after intervention. Overall results indicate that about 80% of our patients benefited from surgery in varying degrees. Only 10% showed post-operative deterioration. One third of operated cases achieved complete working or functional capacity, while in the remaining cases disability persisted. Since long-term results are similar in patients over and under 65 years of age, intervention is recommended even in the older patient if his general condition is good enough to allow surgery.

Rheumatoid arthritis of the lumbar spine leading to anterior vertebral subluxation and compression of the cauda equina

A 71-year-old woman with rheumatoid arthritis suffered a spontaneous anterior subluxation of the fourth lumbar vertebra with compression of the cauda equina. The patient was operated upon with a decompressive lumbar laminectomy and a stabilizing posterior interbody fusion of L4 and L5. Histological examination of the unstable L4-L5 motor segment showed that the apophyseal and discovertebral joints had been destroyed by rheumatoid granulation tissue.