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When That Pain in the Neck is Rheumatoid Arthritis

This report offers a detailed review of rheumatoid arthritis (RA) affecting the neck (cervical spine). Many patients with RA of the hands and feet also develop changes in the neck. Instability of the spine can lead to neurologic signs and symptoms, including sudden death.

Doctors who know about this pattern of disease progression can keep an eye on it with X-rays. Surgery is advised when the patient's neurologic condition gets worse. Other reasons for surgery include constant, severe pain with spinal instability. The authors also point out specific risk factors that doctors must watch for on X-rays.

Type of surgeries and expected results for cervical problems are reported. Patients with RA are complex because the disease affects many systems in the body. Patients become malnourished and run down, making surgery more difficult

Treatment without surgery is also discussed. A soft cervical collar may help some patients but it doesn't change the underlying problem. A program of education, physical therapy, collars, practical aids, and drugs may work best.

New drugs to limit the disease may change the course of RA. Studies also show early surgery is better for some people than waiting. Patients with the best preoperative status have the best recovery and results after the operation.

The authors make a final point that surgical treatment of an unstable neck from RA can be very difficult. Patients must be selected carefully. Special surgical methods are used. An experienced spinal surgeon is best for these patients.

References: David H. Kim, MD, and Alan S. Hilibrand, MD. Rheumatoid Arthritis in the Cervical Spine. In Journal of the American Academy of Orthopaedic Surgeons. November 2005. Vol. 13. No. 7. Pp. 463-474.

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