Rheumatoid Arthritis
You may have heard of rheumatoid arthritis causing pain in the knee, wrist, hands and feet, especially in the mornings. But did you know rheumatoid arthritis can also occur in the cervical spine? Some people call it “arthritis of the neck”.
The cervical spine is a pivot joint below the head that allows your head to rotate, connects the head to the spine, and is the exit point from which nerves start radiating to peripheral parts.
How can rheumatoid arthritis affect the cervical spine?
Rheumatoid arthritis is a chronic, autoimmune disease in which the body’s immune system (which is supposed to attack foreign bodies) mistakenly attacks other healthy body parts, especially joints. When the system attacks the neck’s joints, it causes symptoms and deformity of the cervical spine.
It shows common symptoms, such as tingling pain, neck stiffness, etc. However, if the signs are ignored and rheumatoid arthritis treatment is delayed, it causes more severe symptoms and aggravation of cervical RA.
What are the symptoms of rheumatoid arthritis?
- Pain and swelling around the neck
- Neck stiffness, especially in the mornings
- Pain radiating to the shoulders and arms due to nerve root compression
- Cervicogenic headaches
- Compression of a vertebral artery leading
- Loss of balance or difficulty walking
- Loss of control of bladder and bowels
How common is rheumatoid arthritis in the neck?
Arthritis of the neck is rare, particularly given new ‘medical’ treatments that prevent rheumatoid arthritis from causing too much destruction or deformity.
What are the treatment modalities for cervical rheumatoid arthritis management?
There are multiple treatment modalities for cervical rheumatoid arthritis management. Dr Sherief thoroughly reviews your diagnosis and tailors a rheumatoid arthritis treatment plan for your neck. Treatments may include:
- Medications – Over-the-counter medications such as anti-inflammatory drugs (NSAIDs) help to treat mild to moderate pain and inflammation and slow the progression of RA disease. Typically, rheumatoid arthritis is managed as part of a multi-disciplinary team, including rheumatologists, physiotherapists and more.
- Surgery – Fortunately, surgery is now rarely required but typically involves some form of decompression and fusion – either approaching the spine from the front or back, or both.
Dr Sherief Elsayed is a highly experienced spine surgeon proficient at performing MISS spine surgeries. The surgery’s goals include nerve decompression, relief of pain, and spinal stability.
Rheumatoid arthritis treatment can vary from person to person, depending on complexity and age. However, seeking early cervical spine treatment can reduce the length of treatment with the increased advantage of a quicker recovery.
If you have had a neck ache for more than 2 weeks or have any other significant neck symptoms, visit Dr Sherief Elsayed for a consultation and treatment.
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FAQ
Rheumatoid arthritis is an inflammatory condition that can attack the joints and ligaments in your cervical spine, particularly at the top of the neck where it meets the skull. The inflammation can weaken ligaments, allowing excessive movement or instability between vertebrae. In severe cases, this creates a risk of spinal cord compression. Unlike typical degenerative changes, rheumatoid arthritis causes inflammatory destruction of bone and soft tissues. Symptoms include neck pain and stiffness, but more concerning are neurological symptoms like arm or leg weakness, balance problems, or coordination difficulties indicating cord involvement.
Atlantoaxial instability occurs when rheumatoid disease weakens the ligaments holding the first and second cervical vertebrae (atlas and axis) together. This allows excessive movement between these bones, which can compress the spinal cord or affect blood vessels supplying the brain. Symptoms might include neck pain, headaches, or more seriously, sudden weakness, difficulty walking, or loss of consciousness. It’s one of the most serious complications of rheumatoid arthritis affecting the spine. Regular monitoring with imaging is important for rheumatoid patients, even if neck symptoms seem mild.
No, but cervical spine involvement is relatively common in long-standing rheumatoid arthritis, particularly in patients with severe or poorly controlled disease. Modern rheumatoid treatments have reduced the frequency and severity of spinal complications compared to decades ago. However, anyone with rheumatoid arthritis should be aware of warning symptoms suggesting cervical involvement. If you have rheumatoid disease and develop new neck pain, especially with neurological symptoms, prompt assessment is important. Your rheumatologist and spine surgeon should work together to monitor and manage any cervical complications.
Surgery becomes necessary when there’s significant spinal instability risking cord compression, when the cord is already compressed causing myelopathy symptoms, or when conservative treatment fails to control severe pain. Patients requiring major surgery like joint replacements are sometimes screened for cervical instability beforehand, as neck positioning during anaesthesia could be dangerous if severe instability exists. Surgery typically involves stabilising the affected segments through fusion, sometimes requiring approaches from the front, back, or both. The goal is to protect the spinal cord whilst relieving pain.
Modern disease-modifying drugs and biologics that control rheumatoid arthritis systemically can help prevent or slow cervical involvement, and this is the cornerstone of management. However, once significant structural damage or instability has occurred, medication alone cannot reverse these changes. The inflammatory process can be controlled, but mechanical problems like ligament laxity or bone erosion persist. This is why early aggressive treatment of rheumatoid arthritis is so important. If structural problems develop despite good medical management, surgical stabilisation may become necessary to protect neurological function.