What Is Rheumatoid Arthritis in the Neck?

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Neck pain and other symptoms are common in rheumatoid arthritis (RA). In the highest risk group (male sex, positive rheumatoid factor, longstanding and erosive joint disease), up to 80% of individuals will have involvement of the joints of the cervical spine (vertebra in the neck). With RA, an overactive immune system attacks the joints and causes pain, swelling, and stiffness. The smaller joints of the hands and feet are typically first to be affected. It usually takes many years for the disease to reach the neck, but in one study, about a quarter of people had neck pain at the time their RA was diagnosed.

RA Neck Symptoms

RA neck involvement is characterized by a specific set of symptoms. The most prominent are pain and headache, but it can cause several other symptoms as well.

Neck Pain

Neck pain is the most common symptom of RA of the neck. Its severity varies from person to person. You may 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 neck pain of 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, RA neck pain gets worse if you don't get appropriate treatment. 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 from an overactive immune system that targets healthy tissues.

RA Neck Pain
  • Due to inflammation

  • Worse in the morning, after inactivity

OA Neck Pain
  • Due to natural wear and tear

  • Worsens with activity

Headache

You may also experience headaches when RA affects your neck. Pain can be 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 the head; this is known as a cervicogenic headache. Cervicogenic headaches are usually one-sided and get worse when you move your neck and head. They may feel like other kinds of headaches, including migraines and cluster headaches

Additional Symptoms and Complications

RA in the neck may cause other symptoms if the inflammation or spine instability leads to compression in nearby structures such as the spinal cord, nerve roots, and vertebral arteries.

  • Compression of either the vertebral arteries or spinal cord can reduce blood flow in the neck. The decreased oxygen to your brain that results could mean dizziness and blackouts. 
  • Compression of the spinal cord also affects balance and your ability to walk, and may even cause bowel and bladder control problems.

Unstable vertebrae can shift and also press on the nerve roots and spinal cord, which can cause numbness and tingling that goes up into the back of your head. It can also lead to pain, stiffness, and swelling.

In a small percentage of people, extreme cervical instability can cause quadriplegia (paralysis in all four limbs) or even sudden death.

A serious condition called myelopathy can result from compression that causes injury to the spinal cord. Myelopathy is associated with increased disability and possibly even death.

Symptoms of myelopathy include:

  • Muscle atrophy
  • Weakness
  • Abnormal nerve sensations in the limbs
  • Bowel and/or bladder problems
  • Over-responsive reflexes
  • Spasticity
  • Loss of awareness of the body's position or movements (proprioception)

However, most people with cervical spine problems from RA don't have any symptoms. In fact, research from a 2018 Mexican study finds that asymptomatic cervical instability is quite common in people with RA. The majority of the patients in this study were asymptomatic for neck pain and other cervical spine symptoms despite advanced RA and severe disease activity.

Causes

In RA, chronic, long-term inflammation causes 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 move the neck.

Neck involvement is more likely in people who:

  • Have peripheral joint erosions
  • Don't respond to disease-modifying antirheumatic drugs (DMARDs)
  • Use corticosteroids for a long time
  • Have higher 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 and look for inflammation, misalignment, or joint instability. The physical exam may include checks for neurological symptoms, such as those that can result from spinal cord compression.

They may also request blood work to determine the extent of inflammation and imaging studies to determine whether any joints of your neck are damaged, and if so, which ones and to what extent. Imaging may include X-ray, magnetic resonance imaging (MRI), and/or ultrasound.

Your neck pain may not be identifiable as cervical involvement in RA the first time you talk to your doctor about it. It's also possible that your neck pain could be due to another issue (or compounded by one).

Be sure that your doctor examines your neck at each follow-up appointment so they can spot any RA advancement before it gets too far. Inform them of the extent to which your symptoms are persisting and/or worsening.

Treatment

The use of newer drug treatments has led to a drop in the number of people whose RA impacts the cervical spine, but medication can't reverse damage that’s already occurred. It's likely to progress if you're untreated or under-treated, as well, which could cause permanent joint damage and considerable disability.

Fortunately, those who do have neck involvement have improved surgical options, as well.

Medication

The drugs that help treat RA on a systemic level may improve your neck symptoms, but you may also want to explore treatments specifically for your neck.

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 will likely include:

Depending on your case and the medications you are taking, your doctor may recommend you use one of these 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 such as yoga to reduce stiffness and improve your strength and flexibility. You can focus on exercises for the neck or on the whole body. It's always a good idea to start off slow and gradually increase the intensity of exercise. Always check with your rheumatologist and physical therapist before beginning any neck exercises. Some exercises are dangerous for people with cervical instability from RA.

Several other therapies target the neck directly. For example, 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. Keeping your neck properly aligned can help 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 the two 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 reducing pressure from spinal cord compression. Surgery can also remove any bony spurs (benign bony growth) in the neck, which are common in RA. 

A Word From Verywell

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

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