What is faucet arthropathy and how is it managed?

Facet Arthropathy: Explanation and Management

Facet arthropathy is a specific type of joint inflammation affecting the spine's facet joints, which can cause significant pain and reduced mobility. Treatment typically involves controlling inflammation through medication, physical therapy, and in some cases, interventional procedures such as steroid injections or radiofrequency ablation.

What is Facet Arthropathy?

Facet arthropathy is a form of joint inflammation affecting the small joints of the spine called facet joints. These joints connect vertebrae and allow for movement while maintaining stability. When these joints become inflamed or degenerate, they can cause significant pain and functional limitations.

• Facet arthropathy shares similarities with peripheral arthropathies seen in inflammatory bowel diseases, which are classified as either pauciarticular (Type I) or polyarticular (Type II) based on the number of joints affected 1, 2
• The condition involves inflammation of the joint synovium, which can lead to joint destruction, pain, and decreased mobility 3

Clinical Presentation

• Pain that typically worsens with certain movements, particularly extension and rotation of the spine 4
• Morning stiffness and reduced range of motion in the affected area of the spine 1
• Pain may radiate to surrounding areas, mimicking other conditions like radiculopathy 4
• Symptoms often worsen with prolonged standing or activities that involve spinal extension 4

Diagnosis

• Diagnosis is primarily clinical, based on signs of inflammation and exclusion of other specific forms of arthritis 1
• Physical examination findings may include tenderness over the facet joints and pain with extension or rotation 4
• Imaging studies such as MRI can help confirm the diagnosis by showing inflammation or degenerative changes in the facet joints 1
• In some cases, diagnostic blocks with local anesthetic may be used to confirm that the facet joints are the source of pain 4

Management Approach

Non-pharmacological Interventions

• Physiotherapy is a first-line treatment to improve mobility and strengthen supporting muscles 1
• Rest during acute flares, followed by gradual return to activity 1
• Heat and cold therapy may provide symptomatic relief 1
• Weight management to reduce stress on the joints 1

Pharmacological Management

• Simple analgesia (acetaminophen) as first-line treatment for pain control 1
• Short-term use of NSAIDs for pain and inflammation if no contraindications exist 1
• For persistent symptoms, treatment should focus on controlling inflammation through appropriate medications while avoiding long-term NSAID use due to potential side effects 1
• Muscle relaxants may be considered for associated muscle spasm 1

Interventional Procedures

• For persistent pain unresponsive to conservative measures, image-guided facet joint injections with corticosteroids can provide targeted relief 4

• The procedure involves:

  • Precise needle placement using fluoroscopic or CT guidance 4
  • Injection of long-acting corticosteroid preparation directly into the affected joint 4
  • Usually performed as an outpatient procedure with minimal recovery time 4

• For chronic cases with inadequate response to injections, radiofrequency ablation (RFA) may be considered 4

  • RFA involves using heat generated by radio waves to disrupt the nerves that transmit pain signals from the facet joints 4
  • This can provide longer-lasting pain relief (6-12 months) compared to steroid injections 4

Advanced Management

• For severe, refractory cases, consultation with specialists in pain management, rheumatology, or spine surgery may be necessary 1
• Surgical interventions are rarely indicated but may be considered in cases with significant structural abnormalities or instability 5

Special Considerations

• If facet arthropathy occurs in the context of inflammatory bowel disease or other systemic conditions, treatment of the underlying disease is essential 1
• In patients with inflammatory bowel disease-related arthropathy:
  • Type I (pauciarticular) arthropathy often resolves with treatment of the underlying bowel disease 1
  • Type II (polyarticular) arthropathy may require more aggressive management as it often runs independent of bowel disease activity 1

Prognosis

• With appropriate management, most patients experience significant improvement in symptoms 1
• The condition may be chronic and require ongoing management strategies 1
• Early intervention with appropriate physical therapy and pain management can help prevent progression and disability 1

Common Pitfalls to Avoid

• Relying solely on imaging findings without clinical correlation (facet joint abnormalities on imaging may not always be the source of pain) 1
• Overuse of NSAIDs, especially in patients with inflammatory bowel disease, as this may exacerbate bowel symptoms 1
• Delaying physical therapy, which is crucial for maintaining function and preventing further degeneration 1
• Failing to address psychosocial factors that may contribute to pain perception and disability 1