Rheumatoid arthritis in the neck: Symptoms and management - Medical News Today

Rheumatoid arthritis (RA) is an autoimmune condition that causes inflammation of the joints and can affect the neck.

According to a 2018 literature review, a person will rarely experience RA symptoms in the neck in the early stages of the condition.

In this article, we look at how RA affects the neck. We also discuss the symptoms, diagnosis, and treatment options for rheumatoid arthritis.

RA is an inflammatory arthritis. The immune system attacks the lining of joints, called the synovium, causing inflammation.

The top two vertebrae in the spine, known as C1 and C2, are joints lined with synovium. This means that RA can affect this part of the spine.

RA usually affects smaller joints first, such as those in the hands. As the condition progresses, it can affect other areas of the body, including the cervical spine, or neck. This can cause pain, stiffness, and restricted movement.

While RA in the neck is rare in the first stages of RA, it can occur in 80% of long-term cases. Males and people who test positive for rheumatoid factor antibodies have a higher chance of developing RA in the neck.

According to a 2015 review, the symptoms of RA in the neck are varied, and 33% to 50% of people may experience no symptoms.

However, one of the most common symptoms is neck pain, which can range in severity. The American Academy of Orthopaedic Surgeons notes that this pain can worsen if a person sits in the same position for prolonged periods of time.

RA symptoms are usually worse in the morning and after periods of inactivity.

Other symptoms of RA in the neck can include:

• a dull or throbbing ache at the base of the skull or the back of the neck
• swelling or stiffness in the neck, which may make it difficult to move the neck
• headaches
• neck and shoulder muscle spasms
• a grinding sensation or popping noise when turning the neck
• difficulty walking
• weakness in the hands or legs
• a loss of balance
• dizziness

A person may also experience ear or temporal pain if a nerve, called the greater auricular nerve, becomes compressed.

Rheumatoid arthritis in the neck can also lead to two types of symptoms called radiculopathy and myelopathy.

Radiculopathy occurs due to pressure on the spinal nerve root. This can result in weakness, numbness, pain, and electrical sensations down the arms.

Myelopathy affects the spinal cord over time. Symptoms include radiculopathy, pain, numbness, weakness, and electrical sensations.

Vs. symptoms of osteoarthritis in the neck

Osteoarthritis in the neck is a type of arthritis that happens due to wear and tear of the joints, vertebrae, and discs in the neck.

Most people have no symptoms of osteoarthritis in the neck. If people do have symptoms, they can include:

• mild to severe pain and stiffness in the neck
• pain that is worse after activity
• pain that gets worse when looking up or down, or holding the neck in a set position for a long time
• pain may improve when lying down or resting
• numbness, tingling, or weakness in hands, arms, or legs
• muscle spasms in the neck or shoulders

RA in the neck can also affect surrounding areas, and may cause referred pain in the shoulders, back, and head. Referred pain is when a person feels pain in an area of the body that is not the original source of the pain.

According to the American Migraine Foundation, neck RA can cause referred pain in the form of secondary, or cervicogenic, headaches.

People may feel pain on one side of the head or at the front of the head and behind the eyes.

The 2015 review notes that a person with RA in the neck may also experience an occipital headache. This is due to the compression of nerves.

Although there is currently no cure for RA, a range of treatments can help manage the condition, relieve painful symptoms, and prevent further damage.

Medication

Medications to treat RA can include:

• non-steroidal anti-inflammatory drugs (NSAIDs), to relieve pain and reduce inflammation
• short-term use of corticosteroids, such as prednisone, to relieve pain and reduce swelling
• disease-modifying antirheumatic drug (DMARDs), to slow down the progression of RA and prevent further joint damage
• biologics, to block immune system signals that trigger inflammation

Surgery

If no other treatments are effective in treating RA in the neck, a doctor may recommend surgery. Surgery may be necessary if RA is affecting the stability of the spine or affecting nerves or the spinal cord.

Decompression surgery works to decompress the spine in order to free nerve roots. Spinal fusion is a procedure that fuses segments of the spine together for greater stability.

Alternative treatment options

Physical therapy may help strengthen muscles around the neck, which eases pressure on the spine. People can follow a plan with specific exercises to help improve posture and range of motion.

Other alternative treatments that may help relieve pain include:

Home remedies and lifestyle changes that can help to manage RA in the neck include:

• engaging in regular, light exercise, such as swimming and walking
• using therapeutic neck pillows to support the neck
• applying hot compress to ease aching muscles and stiff joints
• applying cold compress to reduce swelling and numb pain
• stopping smoking
• supporting the back and neck when using a computer or sitting for long periods
• keeping a smartphone at eye level to prevent straining the neck
• practicing good posture by keeping the ears directly above the shoulders, keeping the shoulders back, and the chest open

To diagnose RA in the neck, doctors will use a combination of tests, including:

• a physical examination to check range of motion and sensation in the neck
• a full medical history and assessment of symptoms
• blood tests to check for antibodies and markers of inflammation
• an X-ray and an MRI scan to look at any changes to the spine or alignment, and check for spinal compression
• a CT scan to examine bones in greater detail, and check for any bony growths
• an electromyography (EMG), to check for any nerve compression

RA can cause symptoms throughout the body, which can include:

• weight loss
• low fever
• dry eyes and mouth
• nodules or small bumps under the skin, typically near joints
• shortness of breath or chest pain, due to inflammation
• fatigue
• loss of appetite

People will need to contact a doctor if they have ongoing joint pain in the hands, feet, neck, or any other part of the body that does not respond to treatment.

People will also need to contact a doctor if they have an existing diagnosis of RA and experience any neck pain.

RA is an autoimmune condition that causes inflammation of the joints. Although RA usually affects smaller joints first, such as in the hands and feet, it can progress to the cervical spine, or neck.

A combination of medication, physical therapy, and home remedies can help to manage RA in the neck. If other treatment options are not effective, or RA in the neck affects the spinal cord, people may require surgery.