What Is Rheumatoid Arthritis in the Neck?

Neck pain can be one of the effects of 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 cervical spine joints (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 the first to be affected. The disease usually doesn't affect the neck until several years after symptoms start, but in one study, about a quarter of people had neck pain at the time their RA was diagnosed.

RA Neck Symptoms

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.

But RA neck involvement can cause 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. You may experience a dull or throbbing ache in the back of your neck and around the base of your skull. Joint stiffness and swelling might make it harder to comfortably 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 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, neck pain and other neck symptoms are caused by inflammation from an overactive immune system that targets healthy tissues.

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 control sensation in the upper back. This is known as a cervicogenic headache.

The superficial nerves that control the sensation of the scalp can become irritated or inflamed, leading to occipital neuralgia. And inflammation often contributes to generalized head pain.

Additional Symptoms and Complications

While it's not common, RA in the neck may cause serious problems if 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 flow to your brain could cause dizziness and blackouts. 
• Compression of the spinal cord also affects balance and strength, and may even cause bowel and bladder control problems.

Unstable vertebrae can 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 with symptoms that include:

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

Causes

In RA, chronic, long-term inflammation damages the synovial joints. Synovial joints are the movable joints of the body.

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 head's weight, while the axis helps move the neck.

RA neck involvement is more likely in people who:

• Have peripheral joint erosions
• Don't improve with disease-modifying antirheumatic drugs (DMARDs)
• Use corticosteroids for a long time
• Have higher disease activity

Diagnosis

Your healthcare provider will examine your neck at each follow-up appointment so they can spot any RA advancement before it gets too far. Let them know if your symptoms are persisting and/or worsening.

The first step in diagnosing RA in the neck is a physical examination. Your healthcare provider will want to check your neck range of motion and look for signs of inflammation, misalignment, or joint instability. The physical exam may include checks for neurological signs, such as those that can result from spinal cord compression.

They may also request blood work to determine the extent of inflammation. Imaging studies can help identify 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 could be due to another issue (or compounded by one), and your provider will consider this possibility too.

Treatment

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

The drugs that help treat RA may improve your overall inflammation from RA, as well as your neck symptoms. Other therapies, such as physical therapy and surgery, are specifically tailored to treat your neck issues.

Medication

Over-the-counter medications and prescriptions may help stop inflammation, reduce pain, and slow down disease progression caused by RA. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen sodium) help treat mild to moderate pain and reduce inflammation.

When these medications don’t provide relief, your healthcare provider may prescribe a stronger anti-inflammatory or a corticosteroid. However, the American College of Rheumatology recommends in their treatment guidelines that corticosteroids should be avoided as much as possible, as they can cause side effects like bone loss, drug-induced diabetes, and glaucoma if used continuously.

Your treatment plan will likely include:

• Traditional DMARDs, such as methotrexate, are the first option recommended for most people with RA. They are available in pill form.
• Biologics, such as Orencia (abatacept), are available as injections or intravenous (IV) infusions. These medications are designed to target immune-system malfunction, which causes inflammation.
• Janus kinase (JAK) inhibitors are a newer class of drugs that block a certain type of enzyme that drives autoimmunity and inflammation. Only a few are on the market, including Xeljanz (tofacitinib) and Olumiant (baricitinib).

Depending on your case and the medications you are taking, your healthcare provider may recommend using one of these alone or in combination with other treatments.

Alternative Therapies

Inactivity tends to make RA joint pain worse, so your healthcare provider 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 the whole body.

It's always a good idea to start slow and gradually increase the intensity. Always check with your rheumatologist and physical therapist before beginning any neck exercises. Some exercises are dangerous for people with cervical instability from RA. And typically, it is not recommended to exercise an actively inflamed joint because there's an increased risk of injury.

Several other therapies target the neck directly. For example, your healthcare provider 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 healthcare provider may suggest cervical spine surgery if you have severe, irreversible joint damage or signs of nerve compression or spinal cord 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 (bony growth) in the neck, which are common in RA. 

A Word From Verywell

You should see your healthcare provider 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 healthcare provider 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.