I just found out the is a slight deterioration in my spine. Is this another PsA present or something else entirely
I went with my mom to a neurosurgeon after a MRI had shown severe deterioration of her spine in several places, and despite the horrific look of the images, he said it was a normal part of the aging process. She has osteoarthritis. She has some pain, but no loss of function. Did your doctor seem concerned about it?
I had the same thing as you, Robyn, and my doctor didn't even mention it. It wasn't caused by PsA, though.
I had osteopenia, borderline osteoporosis in my spine at 36. My Rheumy thought it was either steroids or due to the fact I seem to have an overlap IBD to go with my PsA. He certainly didn’t suggest it was coincidental at my age. But it’s all relative - the average population gets osteopenia in their spine somewhere between 60 and 70 years of age…
I haven't even hit 50 yet so I was suprised it was starting. The only thing he told me was to stay active - which is a joke in itself. How am I suppose to be active when I can hardly move some days and what energy I have goes to work and other must dos?
Why are you suprised?
My sister was in a wheel chair by fifty dead by 65. She didn't have time either, was too tired, hurt too much, found a pain management doc though. She refused hormone replacement therapy, because it might cause cancer, didn't take fosomax because she didn't like it.. Worked well for her, till she was dead. My other sister (her twin) was diagnosed at the same time in fact bone scans showed over a hundred fractures. Never missed a day in the gym after, did the replacement therapy, takes fosamax ( similar) is still putting in a 60 hour week as a Regional DNS for a chain of Nursing homes. At 76, shes bent not broken, gets confused as a resident occasionally but clears that up quicklly.There were/are lots of times she doesn't want to be active. But like you say there are must do's.
Its no joke. Its a clear choice. Wish it wasn't so. It takes a while for the necessity to click.
It's that I have anything against being active. Before I got slammed with this mess I was constantly going. Now, between the PsA and the fibro it's just not an option. Somedays it takes all I have just to get out of bed
I hear you, if this was easy they would call it rheumatism........
Thats not entirely true. The main two types are generalized osteoporosis and localized (regional) osteoporosis. In PsA in particular Osteopenia is a known problem as is localized (regional) osteoporosis. Now its known 95% of Osteopenia is cause by osteoporosis. Regional osteoporosis is normally one three other types: Immobilization and disuse, Reflex sympathetic dystrophy syndrome, or Transient regional osteoporosis (generally lower back or hips) Other entities may occasionally mimic transient regional osteoporosis, particularly early in their course including osteonecrosis, septic arthritis, inflammatory arthritis, pigmented villonodular synovitis or idiopathic synovial osteochondromatosis. Any of us who have had a joint replacement know exactly what all that is about (not to mention the bleeding thing)
Diagnoses through X-rays is tough at best. There was a rule way back when called "Resnick's Rule": "You can take a normal patient and an abnormal X-ray technologist and produce osteoporosis at will."
For most of us though osteoporosis as a result Immobilization and disuse is not only possible, but at some point likley especially those of us with the spondylitis type. Trust me on this I am reasonably certain I don't have a menopause problem........... However my areas of osteoporosis are pretty clear.
Anna said:
Bone loss generally has 2 causes: decrease in hormones, such as in post menopause, and poor diet, or both. While arthritis can change your bones, it doesn't change their density.
Long term steroid use can also affect bone density.
http://www.arthritis.org/resources/community-programs/exercise/
Eat a diet rich in calcium and get plenty of exercise.
It sounds complicated and like something I should know. I reread it multiple times but still can't quite get it
Osteopenia and osteoporosis levels are estimated to be as high 33% - 41% with PsA That is far more significant than "aging" or menopause"
While a person near and dear to my self was a part of the Peer review Team and checked the math, he disagreed with the whether it was systemic or localized as the spinal location was confirmed by imaging and not pure reliance on DEXA levels. The hypothesis that "synovial reabsorbing of cytokines is responsible for bone destruction, periarticular vascularization growing and immobilization of the affected joints" lends more to localized version. In any event local or systemic its a good study and pretty consistent with the literature.
Robyn, don't feel bad, I had to read Lamb's post a couple of times too and I have Nursing on my side. It is a subject we should know about but it is hard to understand. I went to WebMD to look up a few things I have forgotten. They have a good section on Osteoporosis, causes and treatment. I did not know drinking soda and smoking puts one at risk also. My mother, who is the smallest female in my family and her osteoporosis test was above normal. I have my father's bones which are much denser but I have not been tested yet. I do take D3 everyday to try and prevent it. It also improves my mood!
They just found out I have low vit d and now I take a supliment
I guess both explanations were a bit complicated. So to answer Robyns first question, YES the deteriration can be a present from PsA.(for 40% of us) If its localized its often from lack of movement and that can be remedied. If its systemic it has to be fought and fought with all tools on all fronts no matter the cause. Blowing it off to menopause, aging etc are unacceptable answers. It is a huge concern or should be a huge concern to all of us. Movement is critical no mater HOW we feel. There are no options or excuses. Everything goes to hell without it.
That is incredibly helpful information. I have been struggling to differentiate what to expect in my future from what I've observed with aging friends and loved ones... After reading what you said, tntlamb, I thought about my aunt (who has PsA) and how differently her spinal arthritis has presented when compared to my mom's... I so wish it was just aging, though! I was diagnosed with spinal involvement at the areas where I have injured my back, and I don't want it to get worse than it is already. Exercise and healthy living it is! And hopefully on to Enbrel next week!
tntlamb said:
I guess both explanations were a bit complicated. So to answer Robyns first question, YES the deteriration can be a present from PsA.(for 40% of us) If its localized its often from lack of movement and that can be remedied. If its systemic it has to be fought and fought with all tools on all fronts no matter the cause. Blowing it off to menopause, aging etc are unacceptable answers. It is a huge concern or should be a huge concern to all of us. Movement is critical no mater HOW we feel. There are no options or excuses. Everything goes to hell without it.
I didn't mean you were being overly complicated Lamb but that the subject is complicated. Thank you for taking the time to break it down for us Lamb. I am particularly dense right now as I am in a flare awaiting Stelara. Let's hope my bones are half so dense.
Michael said “I did not know drinking soda and smoking puts one at risk also”
Our Renal dieticians have always discouraged our patients from drinking soda due to the phosphate content adding to the problems renal patients have with bone metabolism…and are adamant that even health teenagers are at risk with the amount of soda drunk, and the damage to general bone metabolism…sorry a bit off topic
Yes - it is complicated. Certainly there are other autoimmune inflammatory diseases that have localised bone loss that is due to inflammation, not lack of use, and there is still so much we have yet to understand. At the end of the day, there are researchers out there who actually study arthritis from the perspective of a bone metabolic disease (rather than joints, inflammation, or autoimmune), so there's an obvious connection, even though its not one of the top three symptoms for most.
The standard things are never going to hurt - exercise, diet, supplements. (I mean they won't hurt your osteopenia or osteoporosis - they may well hurt your tendons and joints!).
But if you really have significantly low Z scores for your age, you should probably talk to your GP/ Primary about other treatment methods (I'm about to take my own advice.....).
I will continue to follow this thread,I had a bone density scan done 18 months ago,it showed osteopenia. It was done by my endo,who treats my thyroid disease. I was confused at the time because my obgyn & endo said the levels would count as low if I was going through menopause but not if I wasn’t. I have been going through early menopause for 5 years,I’m now 45. Nothing at all was mentioned about my PsA being a contributor. My mother has RA & severe osteoporosis so I figure,losing 18lb,walking everyday & taking my vit D can only help.
Amen Robyn I know how you feel. I have DDD-another abreviation- degenerative disc disease and my doctor says that it is plain ole arthritis from wear and tear and most everyone gets it to some degree.
Robyn said:
It's that I have anything against being active. Before I got slammed with this mess I was constantly going. Now, between the PsA and the fibro it's just not an option. Somedays it takes all I have just to get out of bed