Cervical Spine Pain and Stiffness

The cervical spine is that portion of the spine that runs from the shoulder to the base of the head. There are seven vertebrae and several joints contained in the cervical spine. The joint between the first vertebra of the cervical spine (the atlas) and the occipital bone at the base of the skull allow movements of the head, such as nodding. However, joints between vertebra allow for movement along the entire cervical column. When RA affects the cervical spine, it can result in pain, deformity, and a range of neurological symptoms. This can result in significant disability, affecting an individual’s ability to carry out common daily tasks.

As is true with RA and joints throughout the body, the sooner diagnosis is made and treatment initiated, the greater the likelihood that joint damage can be minimized or prevented. The availability of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics that are effective at slowing or preventing structural damage to the joints means that the joints and other structures in the region of the cervical spine can be preserved and function maintained.

How does RA affect the cervical spine?

RA may affect the cervical spine, that part of the spine between the head and shoulders, resulting in pain and stiffness in the neck that affects the ability of the patient to turn the head and bend the neck. Estimates of how common cervical spine involvement is in RA vary widely, from 17% to 88% of patients. However, with the availability of effective disease-modifying treatments, potential for RA damage to this area of the body has decreased significantly over the past couple of decades.¹

Damage to the cervical spine occurs from joint inflammation. Chronic inflammation may lead to loss of cartilage and bone and loosening of ligaments (the fibrous cords that connect bone to bone and cartilage to cartilage). Formation of pannus (a build-up of tissue composed of immune cells) in affected joints may lead to a narrowing of the joint area and result in compression of the spinal cord, causing a range of nerve symptoms, including pain and sensory loss in the hands and feet.^1-3

Because of the position of the cervical spine, advanced imaging techniques, including magnetic resonance imaging (MRI) or computed tomography (CT) scan, may be necessary to evaluate joint involvement.²

RA-related joint involvement in other parts of the spine occurs infrequently. RA can, however, affect the joint of the larynx (called the cricoarytenoid joint), which is in the vicinity of the cervical spine. Cricoarytenoid involvement can result in vocal hoarseness.¹

How is RA-related cervical spine involvement treated?

Initial approach to management of RA-related symptoms affecting the cervical spine should include medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoids). Patients who experience nerve pain and other symptoms may benefit from medications used to treat neuropathic pain. These medication block nerve signaling and may provide temporary relief of symptoms.³

Other interventions that may be useful in controlling pain include use of a neck brace or collar and application of heat or cold. It is not known if physical therapy or rehabilitation focusing on strengthening neck muscles provides benefit. Spinal manipulation should not be used in patients with RA-related involvement in the cervical spine.^2,3

If symptoms persist and joint damage progresses, surgical fusion of vertebrae may be used to prevent nerve damage.²