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Rheumatoid arthritis (RA) is often addressed with regards to its effects on joints in the extremities. However, many people with RA experience significant effects on the cervical spine, which can have permanent or life-threatening implications. Although there is no cure, there are ways to minimize significant effects on the neck.
The damaging effects of RA on the cervical spine are often not visible on x-ray unless there is evidence of bone spurs or decreased space between the vertebrae. Much like it affects other joints in the body, RA can slowly deteriorate the supporting structures of the joints. This can lead to joint instability and partial or complete dislocations. The neck is no exception. Periodic monitoring of your neck with CT scans or MRI can offer better visualization of changes than x-ray.
Increased Neck Support
If you experience flares of neck inflammation, you may want to talk with your doctor about the option of having a cervical collar readily available. Although wearing a collar can be uncomfortable and will limit your range of motion, it can provide much needed support especially during flares when your neck is most vulnerable to damage. If your RA is poorly controlled or progresses and you experience continuous inflammation in your neck, wearing a cervical collar continuously may be a non-invasive option for support.
Local Anti-inflammatory Medications
You are likely on medications in an attempt to control the underlying disease process, but you may continue to experience flares in your neck or have ongoing inflammation. Typically, injectable steroids are used to help control inflammation in a single location, but the risks associated with steroid injections can be especially difficult when it concerns your neck. Since repetitive use of injectable steroids can make bones more fragile, you and your doctor must weight this concern against the instability created by the inflammation.
The part of the cervical spine most commonly affected by RA are the first two vertebrae, C1 and C2. Weakening of this area due to chronic inflammation can cause the vertebrae to slip over one another, leading to compression of the spine. Fusing the two vertebrae together may be a good option when there is evidence of cervical spine damage and concerns of instability. Since the connection between the two vertebrae is important for rotation of the skull on its axis, rotating your head from side to side will no longer be possible.
Since the first two vertebrae of the cervical spine protect the critical junction between the brain and spinal cord, ongoing inflammation in this location is especially troublesome. Aggressive treatment and consistent monitoring can reduce the likelihood of catastrophic spinal cord damage.