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Suggest Treatment For Spinal Arthritis In An Elderly Person
Question: My 89 year old mother has spinal arthritis. IN the past she could walk around 15 minutes before having to sit down. Now in the last week, the pain upn standing is soo acute she winces and needs to use a walker within a few minutes. The pain was originally in the lower lumbar and now over the last week its predominantly in the right buttock quadrant focused and not the back. She gets relief upon sitting
and lying down. Best early in the morning.
She had a recent spinal xray that showed no compression fractures. However her doctor believes the pain is just from arthritis and the physiotherapist believes its a facet joint irritation/compression
She was given 0.5 morphine pill the last two days which gave her no relief but drowsiness.
Others have suggested galipentin
1. What condition is she suffering from
2. What would be the best medication
She already has tried tylenol and takes xarelto, and fleccanide as well
and lying down. Best early in the morning.
She had a recent spinal xray that showed no compression fractures. However her doctor believes the pain is just from arthritis and the physiotherapist believes its a facet joint irritation/compression
She was given 0.5 morphine pill the last two days which gave her no relief but drowsiness.
Others have suggested galipentin
1. What condition is she suffering from
2. What would be the best medication
She already has tried tylenol and takes xarelto, and fleccanide as well
Brief Answer:
If possible,she should get a MRI of spine.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through the clinical details of your mother,as you have mentioned. The important issue here is whether she is having some nerve radicles compression(radiculopathy) due to degenerative spine/disc disease or not or is it just spinal arthritis along with facet joint inflammation. A MRI of lumbosacral spine will be of great help and should be done,if possible.Gabapentin must have been prescribed,considering the radiculopathy aspect.
Besides,I need to know some details which may help to approach the diagnosis better-
1)Does she have tingling or numbness in extremities/lower limbs?
2)Does she have any area of loss of sensations in lower limbs?
3)Does she have normal bladder functions?Any difficulty in passing urine?
4)Does she have any weakness in lower limbs?
Lastly,please upload her X-ray and other documents,if available.
Hope that helps.I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
If possible,she should get a MRI of spine.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through the clinical details of your mother,as you have mentioned. The important issue here is whether she is having some nerve radicles compression(radiculopathy) due to degenerative spine/disc disease or not or is it just spinal arthritis along with facet joint inflammation. A MRI of lumbosacral spine will be of great help and should be done,if possible.Gabapentin must have been prescribed,considering the radiculopathy aspect.
Besides,I need to know some details which may help to approach the diagnosis better-
1)Does she have tingling or numbness in extremities/lower limbs?
2)Does she have any area of loss of sensations in lower limbs?
3)Does she have normal bladder functions?Any difficulty in passing urine?
4)Does she have any weakness in lower limbs?
Lastly,please upload her X-ray and other documents,if available.
Hope that helps.I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr P
No to all your 4 questions.
She has it once where she was sitting and pain radiated from lumbar down her leg
but her primary symptoms are acute lower back pain when standing. In the past she could walk or stand 15 minutes before she would have to sit down.
So a week ago - she had terrible lumbar pain - Please see the xrays posted on my first question to a radiologist. I cant load them up easy.
Now in the last few days -the pain has shifted to the buttock right - its lower than the hip pivot point but higher the lower lumbar. She historically has had this - either buttock side or right across the lumbar.
She will get up from her chair - have no immediate pain for a a couple of minutes, then if she gets up again from toilet - she winces in pain from the right side. She can manage the pain with a walker but this is all not good.
I doubt she will get an MIR
No to all your 4 questions.
She has it once where she was sitting and pain radiated from lumbar down her leg
but her primary symptoms are acute lower back pain when standing. In the past she could walk or stand 15 minutes before she would have to sit down.
So a week ago - she had terrible lumbar pain - Please see the xrays posted on my first question to a radiologist. I cant load them up easy.
Now in the last few days -the pain has shifted to the buttock right - its lower than the hip pivot point but higher the lower lumbar. She historically has had this - either buttock side or right across the lumbar.
She will get up from her chair - have no immediate pain for a a couple of minutes, then if she gets up again from toilet - she winces in pain from the right side. She can manage the pain with a walker but this is all not good.
I doubt she will get an MIR
Brief Answer:
MRI Spine/BMD scan
Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.
Its pretty clear that she has a degenerative spine(osteophytes in x-ray) with probable osteoporosis.Pain can be a manifestation of both.
I would suggest that she should undergo a bone mineral density(BMD) for osteoporosis and MRI of spine.She may need bisphosphonate therapy for osteoporosis along with calcium/vitamin D supplementation.At the same time,if radiculopathy is detected,she will have to be treated for the same.Pain is likely to improve with treatment.
Hope that helps.If you have any further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
MRI Spine/BMD scan
Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.
Its pretty clear that she has a degenerative spine(osteophytes in x-ray) with probable osteoporosis.Pain can be a manifestation of both.
I would suggest that she should undergo a bone mineral density(BMD) for osteoporosis and MRI of spine.She may need bisphosphonate therapy for osteoporosis along with calcium/vitamin D supplementation.At the same time,if radiculopathy is detected,she will have to be treated for the same.Pain is likely to improve with treatment.
Hope that helps.If you have any further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If her pain is now concentrated in rather the hip/buttock area than vertical spinal column - I don't know if your recommedations are truly valuable what the true cause here is!
Brief Answer:
Your concerns are valid.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I understand your concerns,but then we come across patients with such clinical profile everyday in Outpatient, and this is the plan of management we follow.
Still if I can be of any help,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Your concerns are valid.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I understand your concerns,but then we come across patients with such clinical profile everyday in Outpatient, and this is the plan of management we follow.
Still if I can be of any help,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
I spent today 5 hours at the local ER to get an MIR
A 90 year old woman who has acute pain upon standing, sitting down or walking
who without a walker is not deemed to be an emergency.
Unless she cant urinate or defecate would allow an MIR
She was given another set of xrays for back and hip deeming significant osteoarthtitis and not inflammatories because she takes a blood thinner.
ER doctor stated the arthritis doesn't look new - what that means on a spinal xray.
She was allowed to take for 3 days off the counter inflammatories
An experienced physiotherapist who examined my mother recently stated
he feels the ligament that's near the sacro-illeal joint is the major problem
Health care in Canada is so good - that's irony!
A 90 year old woman who has acute pain upon standing, sitting down or walking
who without a walker is not deemed to be an emergency.
Unless she cant urinate or defecate would allow an MIR
She was given another set of xrays for back and hip deeming significant osteoarthtitis and not inflammatories because she takes a blood thinner.
ER doctor stated the arthritis doesn't look new - what that means on a spinal xray.
She was allowed to take for 3 days off the counter inflammatories
An experienced physiotherapist who examined my mother recently stated
he feels the ligament that's near the sacro-illeal joint is the major problem
Health care in Canada is so good - that's irony!
Brief Answer:
ER doctor probably referred to severe arthritis.
Detailed Answer:
Hi,
Thanks for being in follow-up.
'arthritis doesn't look new' is probably referred to severe advanced osteoarthritis.Osteoarthritis,otherwise is conventionally considered as non-inflammatory.It is actually,a degenerative joint disease.
Blood thinners can cause osteoporotic changes.However,BMD scan can tell the degree of osteoporosis.Osteoporosis commonly causes pain,that can be very severe at times.Treating it is of paramount importance.Women in elderly age group,are otherwise at risk for osteoporosis.Blood thinners may be adding upon the disease severity.
Did they make a comment on sacro-iliac joint inflammation?
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
ER doctor probably referred to severe arthritis.
Detailed Answer:
Hi,
Thanks for being in follow-up.
'arthritis doesn't look new' is probably referred to severe advanced osteoarthritis.Osteoarthritis,otherwise is conventionally considered as non-inflammatory.It is actually,a degenerative joint disease.
Blood thinners can cause osteoporotic changes.However,BMD scan can tell the degree of osteoporosis.Osteoporosis commonly causes pain,that can be very severe at times.Treating it is of paramount importance.Women in elderly age group,are otherwise at risk for osteoporosis.Blood thinners may be adding upon the disease severity.
Did they make a comment on sacro-iliac joint inflammation?
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It was a young resident and she stated she saw nothing other than osteoarthritis.
The images would be reviewed by a radiologist within 24 hours.
Last weeks xray report stated the sacro illeal joint was normal.
The images would be reviewed by a radiologist within 24 hours.
Last weeks xray report stated the sacro illeal joint was normal.
Brief Answer:
Please get back with the radiologist's report.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I shall be looking forward to the radiologist's opinion.Please get back to me as the report arrives.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Please get back with the radiologist's report.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I shall be looking forward to the radiologist's opinion.Please get back to me as the report arrives.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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