Spinal Symptoms of Rheumatoid Arthritis

When rheumatoid arthritis (RA) affects your spine, it can cause neck pain, back pain, and radiculopathy (pain that radiates to the legs or arms) due to compression of your nerve roots or nerves within the spinal cord. RA is more common in some areas of the spine than others.

Frequent Symptoms

The most common symptoms of RA in the spine (as with other joints) include:

• Pain and stiffness
• Joint inflammation
• Warm joints
• Loss of flexibility and mobility

It's more common for RA to impact the cervical spine (neck region) than the lumbar spine or sacroiliac joints in the lower back.

Cervical Involvement

In addition to impacting your joints, RA can cause your ligaments, which connect bones to other bones, to become lax. When that happens to the ligaments supporting the first and second cervical vertebrae (C1 and C2), it can lead to instability, subluxations (partial dislocations), and possibly spinal cord compression.

Symptoms of cervical RA involvement include:

• Headaches at the base of the skull
• Pain that radiates down your arms (cervical radiculopathy)
• Weakness and tingling in the arms, hands, and fingers
• Popping and cracking when you move your neck (crepitus)

Your healthcare provider will likely evaluate your cervical region often to look for early signs of instability.

Lumbar Involvement

While less common, the lumbar spine (the area of your lower back that curves inward) can be affected by RA. It can result in impingement or inflammation of the nerves coming from your spinal cord. Facet joints, which limit the twisting movement of the spine, may be involved as well.

Symptoms can impact the lower back, buttocks, hips, and legs. They include:

• Pain
• Stiffness
• Abnormal nerve sensations (e.g., tingling)
• Muscle cramping
• Feelings of weakness and heaviness
• Pain that radiates down your legs (lumbar radiculopathy)
• Stiffness in the lower back
• Symptoms that are more severe when standing or walking and relieved by sitting or leaning forward

Because less than half of people with RA have lower back involvement, your healthcare provider will likely check for other possible causes of these symptoms, such as vertebral compression fractures.

Progressive Symptoms

In progressive forms of the disease, joint deterioration can lead to compression (pinching) of the spinal cord or spinal nerve roots.

Common symptoms of compression include:

• Difficulty walking, a sign of increased pressure on the spinal cord
• Changes to balance and coordination, which may be signs of spinal cord involvement
• Bowel or bladder control problems (e.g., incontinence, inability to urinate, or inability to control the bowels), which may indicate spinal cord involvement
• Hyperreflexia (over-responsive reflexes)

Complications

In some cases, rheumatoid arthritis damages the facet joints in the spine that keep the spine from twisting too far. When that happens, a condition known as spondylolisthesis may develop.

With spondylolisthesis, an upper vertebra slides forward onto the top of the one beneath it, where it can put extra pressure on the spinal cord or the nerve roots where they exit the spine. This may cause the same symptoms related to compression.

When to See a Healthcare Provider

If you have RA and develop new symptoms in the spine, talk to your healthcare provider as soon as possible about what treatment changes or additions may help control symptoms and slow the advancement of your disease.

If you aren't diagnosed with rheumatoid arthritis but develop symptoms consistent with RA in the spine, you should make an appointment with your healthcare provider to begin the diagnostic process. Either way, the earlier you get treatment, the better off you are likely to be down the road.

To prepare for your appointment, download our printable Doctor Discussion Guide below. It'll help you learn relevant terminology and questions to bring up the next time you speak with your healthcare provider.

Rheumatoid Arthritis Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Download PDF

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