Systemic lupus erythematosus (SLE) is a chronic autoimmune disease where the immune system mistakenly targets its own healthy tissues, leading to widespread inflammation and damage. While lupus commonly affects organs like the skin, joints, and kidneys, it can also impact the spinal column. Spinal involvement is not a defining characteristic for most with lupus, but it represents a serious complication when it occurs.
The connection between lupus and spinal issues is rooted in the disease’s inflammatory nature. Understanding this link helps in recognizing potential back-related symptoms and seeking medical evaluation. Any new back pain or neurological changes in a person with lupus warrant an investigation to determine if they are connected to the autoimmune process or a separate issue.
How Lupus Affects the Spinal Column
Lupus can impact the spinal column through several mechanisms driven by widespread inflammation. One pathway is the direct inflammation of spinal structures, manifesting as spondylitis (inflammation of the vertebrae) or arthritis in the facet joints. The ligaments and muscles supporting the spine can also become inflamed, a condition known as myositis, leading to pain and stiffness.
Another mechanism is vasculitis, or inflammation of the blood vessels. When lupus causes vasculitis in the arteries supplying the spinal cord, it can restrict blood flow. This lack of oxygen can lead to tissue injury or death (ischemia), affecting both the vertebrae and the nerve tissues of the spinal cord.
The immune system’s attack can also be aimed directly at the central nervous system. Autoantibodies characteristic of lupus can target nerve cells within the spinal cord or the myelin sheath that insulates them, disrupting nerve signals. The presence of certain autoantibodies, such as antiphospholipid antibodies, is linked to a higher risk of blood clots that can obstruct blood flow to the spinal cord.
Symptoms and Associated Spinal Conditions
Symptoms from lupus’s effects on the spine vary depending on the structures involved. Patients may experience localized back pain that is dull, aching, or sharp and radiating. Morning stiffness and reduced mobility are common, as are muscle spasms and weakness in the back when surrounding muscles are inflamed.
More serious neurological symptoms can arise when the spinal cord is affected. These can include numbness, tingling, or a loss of sensation below the level of the inflammation. Weakness in the arms or legs, sometimes progressing to paralysis, is a sign of serious spinal cord involvement, as is a loss of bladder or bowel control.
These symptoms are often linked to specific conditions. Lupus myelopathy (transverse myelitis) is an inflammatory condition affecting a segment of the spinal cord, causing sensory and motor dysfunction. Another condition is avascular necrosis (osteonecrosis), the death of bone tissue from a lack of blood supply, which can be accelerated by long-term corticosteroid use. When it occurs in the vertebrae, it can lead to bone collapse, pain, and spinal deformity.
The Diagnostic Process
Diagnosing spinal involvement in a person with lupus requires distinguishing it from other causes of back pain. The process begins with a detailed patient history and a physical examination. A doctor will discuss the nature of the symptoms and their progression, and the physical exam includes a neurological assessment to test reflexes, muscle strength, and sensation.
Blood tests are used to evaluate the activity of the underlying lupus. While they cannot visualize the spine, they can reveal heightened levels of specific autoantibodies or low levels of complement proteins. These markers suggest an active lupus flare, making it more likely that the spinal symptoms are a manifestation of the disease.
Imaging studies are used for visualizing the spine and identifying the source of the problem. Magnetic Resonance Imaging (MRI) provides detailed images of the spinal cord, nerves, and soft tissues, showing areas of inflammation or damage from myelitis. X-rays and Computed Tomography (CT) scans are better for examining bones and are used to detect fractures or bone collapse from avascular necrosis.
In complex cases, a lumbar puncture (spinal tap) may be performed. This procedure involves collecting a sample of cerebrospinal fluid from the spinal canal. Analyzing this fluid can reveal signs of inflammation or help rule out infections and other neurological diseases that can mimic lupus-related spinal conditions.
Management and Treatment Strategies
The goal of managing lupus-related spinal conditions is to control the underlying autoimmune disease and reduce inflammation. The first line of treatment for a severe flare like lupus myelitis often involves high-dose corticosteroids, such as prednisone. These medications suppress the immune system’s attack and lessen damage to the spinal cord.
For long-term management and to prevent relapses, immunosuppressant drugs like cyclophosphamide, azathioprine, or mycophenolate mofetil are used. These medications work by controlling the overactive immune system. Biologic therapies, which are more targeted, have also become an option, with the choice of medication depending on the condition’s severity and the patient’s health.
Treatment also focuses on alleviating specific symptoms. Pain and stiffness may be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers. Physical therapy is a component of recovery that helps improve mobility, strengthen the muscles supporting the spine, and develop strategies to manage chronic pain.
Occupational therapy helps individuals adapt their daily routines if they have lasting neurological deficits. In rare situations where there is spinal instability from a vertebral collapse due to avascular necrosis, surgery may be necessary. This intervention aims to stabilize the spine and prevent further neurological injury.