Rheumatoid Arthritis in the Neck

Overview, Symptoms, Diagnosis, and Treatment

Cervical Spine
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Rheumatoid arthritis (RA) is a chronic inflammatory disease where the body mistakenly attacks the joints. An overactive immune system is to blame and results in joint pain, swelling and stiffness. RA often starts in the smaller joints of the hands and feet. But as the disease progresses, it spreads to other parts of the body, including the neck. It usually takes many years after the onset of the disease for the neck to be affected.

RA and the Neck

One 2018 report in Rheumatology International finds that cervical spine (neck) involvement is present in up to 80% of people with RA who have joint damage. Chronic, long-term inflammation is to blame for the destruction of the synovial joints, including in the neck. Synovial joints are those that promote movement. When RA damages the neck’s synovial joints, the cervical spine can become unstable. While there are many synovial joints in the cervical spine, RA tends to attack the one between the atlas and the axis, the first and second bones of the spine. The atlas is responsible for supporting the weight of the head, while the axis helps to move the neck.

If your vertebrae are unstable, they can shift and start to press on the nerve roots and the spinal cord. When this happens, you may have numbness and tingling in the neck that goes up into the back of the head. In addition, you will experience joint pain, stiffness, and swelling.

Symptoms

RA neck involvement is characterized by a specific set of symptoms, including pain and headache.

Neck Pain

Neck pain is the most common symptom of RA of the neck and its severity will vary for each person affected. You may also experience a dull or throbbing ache in the back of the neck and around the base of the skull. Joint stiffness and swelling might make it harder to move your head.

The type of neck pain experienced with RA is different than that of a neck injury. With an injury, you may experience stiffness and pain that improves over days and weeks. However, with RA neck pain does not get better and worsens without appropriate treatment. And even if your symptoms do improve, the inflammation, pain, swelling, and stiffness may eventually return.

People with osteoarthritis (OA) also experience neck pain, but their pain is due to natural wear and tear. In people with RA, pain, other neck symptoms, and joint damage are due to inflammation. OA neck pain often worsens with activity whereas RA neck pain usually is worse in the morning and after inactivity.

Headache

You may also experience headaches when RA affects your neck. Pain can due to inflamed or irritated spinal nerves on each side of the vertebrae that supply feeling to the back of the scalp. Often, RA of the neck is felt as referred pain in thee head, also known as cervicogenic headaches They may feel like other kinds of headaches, including migraines and cluster headaches. 

Cervicogenic headaches are usually one-sided and will worsen will neck and head movement.

Additional Symptoms

In addition to headache and neck pain, RA in the neck may cause other symptoms if the inflammation is compressing nearby structures such as the spinal cord, nerve roots, and vertebral arteries.The compression can reduce blood flow in the neck and eventually lead to a reduction in the amount of oxygen going to the brain. Decreased oxygen to your brain could mean dizziness and blackouts. Compression of the spinal cord also affects balance and ability to walk, and may even cause bowel and bladder control problems. Compression of either the vertebral arteries or spinal cord can cause dizziness and blackouts.

It is common for people who have cervical spine problems to not experience any symptoms. In fact, research from a 2018 Mexican study finds that asymptomatic (no symptoms) cervical instability is quite common in people with RA. The majority of the patients in this study that were asymptomatic for neck pain and other cervical spine symptoms had advanced disease and severe disease activity.

Diagnosis

The first step in diagnosing neck RA is a physical examination. Your doctor will want to check the range of motion in the neck to look for inflammation, misalignment or joint instability. He or she may request blood work to determine the extent of inflammation and imaging studies (X-ray, MRI or ultrasound) to determine if there is any damage to the joints of your neck.

Treatment

RA in the neck will progress over time and potentially cause permanent joint damage. There is no cure for RA, but a variety of treatment options can help improve symptoms and reduce inflammation.

Medication

Over-the-counter medications and prescriptions are helpful in stopping inflammation, reducing pain, and slowing down disease progression in people with RA. For example, non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen sodium) are helpful for treating mild to moderate pain and reducing inflammation. When these medications don’t provide relief, your doctor may prescribe a stronger anti-inflammatory or a corticosteroid. Prednisone is the most prescribed corticosteroid for people with RA. 

Your treatment plan may also include traditional modifying anti-rheumatic drugs (DMARDs) and biological DMARDs (biologics). Traditional DMARDs, such as methotrexate, are available in pill form and taken by mouth, while biologics, such as Orencia (abatacept) are available as an injection or intravenous (IV) infusion.  These medications are designed to target the parts of the immune system causing inflammation and the immune system to malfunction. You can take these medications alone, or in combination with other treatments.

Alternative Therapies

Inactivity tends to make RA joint pain worse, so your doctor will likely recommend light exercise to reduce and improve your strength and flexibility. It is always a good idea to start off slow and gradually increase the intensity of exercise. Your doctor may recommend massage therapy to reduce pain and stiffness in the joints of your neck, or physical therapy to improve range of motion.

Therapeutic neck pillows can help provide neck and head support while you sleep. This way your neck stays properly aligned, and you wake up with less pain and stiffness. 

Hot and cold therapies are also helpful for reducing inflammation, swelling, stiffness, and pain. Use a hot or cold compress for 10 minutes at a time, alternating between hot and cold throughout the day.

Surgery

Your doctor may suggest cervical spine surgery when you have severe, irreversible joint damage or signs of nerve compression. Surgery may be helpful in re-stabilizing the first and second vertebrae and reduce pressure from spinal cord compression. Surgery can also remove any bony spurs (benign bony growth) in the neck. 

A Word From Verywell

You should see your doctor if you experience neck pain and that pain starts to affect your daily life and doesn’t respond to treatment, especially if you have already been diagnosed with RA. You shouldn’t put off talking to your doctor if neck pain includes numbness, tingling, pain that radiates into your arm, and headaches. A proper diagnosis can reduce pain and inflammation, slow down the potential for joint damage and disability, and improve your quality of life.

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  1. Bodakçi E, Üsküdar Cansu D, Ertürk A, et al. Can neck pain be an initial symptom of rheumatoid arthritis? A case report and literature review. Rheumatol Int. 2018 May;38(5):925-931. doi:10.1007/s00296-018-4019-z

  2. Geraldo-Flores NA, Merlos-López RJ, Rodríguez-Wong JA, et al. The severity of rheumatoid arthritis as a timely predictor of instability in the asymptomatic cervical spine. Acta Ortop Mex. 2018 Nov-Dec;32(6):342-346. https://www.ncbi.nlm.nih.gov/pubmed/31184005