Can Rheumatoid Arthritis Affect the Cervical Spine?
Treatment for cervical spine conditions caused by RA mainly focuses on preventing any serious complications.

Yes, rheumatoid arthritis (RA) can affect the neck or cervical spine. It is the third most common site to be affected by RA, the top two being the small joints of the feet (metatarsophalangeal joints) and hands (metacarpophalangeal joints).

  • Among the bones of the spine (vertebrae), the cervical region is most commonly affected by RA, whereas those in the upper and lower back region (thoracic and lumbar spine) are rarely affected.
  • The medical term for this condition is rheumatoid spondylitis.

How does rheumatoid arthritis affect the cervical spine?

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition. In autoimmune diseases, the immune system, which is supposed to fight infections and other harmful agents, mistakenly targets and attacks the body’s tissues. This results in chronic inflammation that causes damage to various tissues in the body, such as the joints, skin, eyes, heart, lungs, and kidneys.

The autoimmune attack in RA can target the bones of the spine, typically those in the neck or cervical region. This may cause three main types of abnormalities in the cervical spine:

  1. Atlantoaxial instability: Most common abnormality seen in RA that affects the cervical spine. The atlantoaxial joint is the joint between the atlas and axis (first two cervical bones or vertebrae). This abnormality results in the misalignment of the two cervical vertebrae.
  2. Superior migration of the odontoid: The odontoid process is a projecting bony part of the second cervical vertebra on which the first cervical vertebra rotates. This deformity can result in pressure on the lower part of the brain that may cause neurological dysfunction and even death in severe cases. 
  3. Subaxial subluxation: Least common type of cervical spine deformity. It can result in compression of the spinal cord.

What are the symptoms of rheumatoid arthritis of the cervical spine?

The symptoms of rheumatoid arthritis (RA) of the cervical spine may vary depending on the type and severity of the abnormality caused.

Symptoms may include:

Other classical symptoms of RA, such as pain and swelling in small joints (those of the hands or feet) and morning stiffness, may also be seen.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

How do doctors diagnose rheumatoid arthritis of the cervical spine?

Doctors usually diagnose rheumatoid spondylitis based on:

  • The detailed medical history of patients, including the symptoms, history of injury, any family history of rheumatoid arthritis, any ongoing medications, and any underlying health issues
  • Physical examination to look for reflexes, stiffness any bony abnormalities, etc.
  • Investigations including:

How is rheumatoid arthritis of the cervical spine treated?

Treatment mainly focuses on preventing any serious complications. As the cervical vertebrae are close to the lower part of the brain, several nerves, and the spinal cord, untreated spondylitis can result in permanent neurological damage and even death. Most patients may be managed with conservative treatment; however, others may require surgery. 

Surgery may help relieve pressure on the nerves, brain, or spinal cord. It may also reduce the symptoms while improving the stability of the cervical spine.

The non-surgical treatments generally include:

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Medically Reviewed on 10/20/2022
References
Image Source: iStock image

https://emedicine.medscape.com/article/1266195-overview#a4

https://www.uptodate.com/contents/cervical-subluxation-in-rheumatoid-arthritis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553335/#:~:text=Rheumatoid%20arthritis%20(RA)%20is%20a,or%20subaxial%20subluxation%20(SAS)