RA Can Be a Literal Pain in the Neck
There’s been a nagging wondering over the past 18 months if RA was impacting my neck. Radiating sharp pain in the neck, shoulders, and arms increased in intensity. Numbness and tingling in all fingers began to be felt. I had an x-ray, saw a chiropractor, had massage therapy, did gentle exercises at home, took muscle relaxants, applied lots of muscle lotions, got an MRI, went to a physical therapist, saw multiple doctors, got an epidural steroid injection, had a nerve conduction and electromyogram (muscle) test, progressively took more and stronger pain medication, and eventually ended up in the emergency room.
The final diagnosis was degenerative arthritis in vertebrae C5 through C7, two herniated discs pushing into the spinal cord (stenosis), and bone spurs pushing into radiating nerves. A four-hour surgery is in store this week. The neurosurgeon will remove the two damaged discs, cut away bone spurs, and fuse three vertebrae with titanium hardware. A long recovery is in store but the notion of no longer dealing with the symptoms provides motivation to proceed.
Can neck pain be a symptom of RA?
Various views from multiple specialist doctors about whether or not the neck problems were caused by rheumatoid arthritis were declared. Some tended to avoid the question probably because they weren’t exactly sure. But the diagnosis notes from several doctors including an emergency room doctor, an orthopedic surgeon, a pain medicine doctor, and a neurosurgeon stated the following (ICD diagnostic codes included):
- cervical degenerative disc disease,
- degenerative joint disease,
- chronic neck pain (723.1),
- cervical disc herniation (722.0),
- cervical radicular pain (723.4),
- cervical spondylosis with myelopathy (721.1),
- AND rheumatoid arthritis (714.0).
I’ve had the RA diagnosis for sometime now. But the fact that it was included on the list right next to the neck problems lends evidence that these doctors believe that RA must be contributing. When I asked the neurosurgeon, he quickly stated that is was probably caused by a combination of the RA and genetics.
What is atlantoaxial subluxation?
When it comes to RA, we tend to focus on the traditional peripheral joints that are impacted like fingers, knees, and toes. But it is clear from the research literature that RA can impact the neck.1 Up to 90% of RA patients show changes in the neck via x-rays.2 One of the more serious neck conditions related to RA is atlantoaxial subluxation which involves a stair stepping of the vertebrae. This condition occurs in up to 30% of RA patients.3
How does atlantoaxial subluxation happen?
When this situation occurs at the C1-C2 levels right next to the skull, it can put dangerous compression on the brain stem resulting in permanent nervous system damage and even death. Up to 12% of RA patients show this symptom.4 Given the seriousness of this condition, some researchers recommend surgical intervention at an earlier stage before irreversible damage occurs.5
Atlantoaxial subluxation in other autoimmune conditions
In addition to RA, this dangerous condition can be caused by several auto-immune arthritis diseases including ankylosing spondylitis, psoriatic arthritis, and lupus.6
Don't ignore neck symptoms
Radiologists know the critical impact of RA of this part of the neck. On my latest neck MRI, the report stated, “Mild degenerative change at the C1-C2 articulation, but no significant canal stenosis.” This report indicates that I need to pay attention to these joints over the long run but that my current symptoms are likely not related to C1-C2.
Pay attention to pain, numbess, and stiffness
If you have RA, don’t ignore neck symptoms including the more common pain, stiffness, numbness and tingling in fingers, and pain radiating down the shoulders and arms. Most importantly, if you are experiencing a change in bladder and bowel control and/or gait disturbances, please seek medical attention immediately as these may be symptoms of serious spinal cord compression.
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