Rheumatoid Arthritis Of The Neck

Welcome back Rheumatology Fans,

Rheumatoid Arthritis (RA) is a peripheral disease, so what is it doing affecting the neck… This is of interest for 2 reasons - it is reasonably unusual and it can be dangerous!

In this article:

• Introduction

• Assessment & Investigation

• Considerations

Introduction

RA of the neck primarily affects the atlantoaxial (C1-C2) joint. It is an autoimmune disease characterised by chronic synovial inflammation, leading to progressive joint destruction, instability, and potential neurological complications.

The pathophysiology of RA in the cervical spine is the same as in the periphery. C1/2 is a synovial joint, persistent auto-inflammation causes chronic synovitis eventually leading to cartilage and bone erosion.

The persistent inflammation weakens the transverse ligament of the atlas, resulting in atlantoaxial subluxation (AAS). This instability increases the risk of spinal cord compression, causing myelopathy, pain, and neurological deficits.

The disease progresses with bone erosion, ligament laxity, and potential fusion of vertebrae, leading to reduced neck mobility, pain, and functional impairment. Left untreated, cervical RA can result in severe neurological compromise, respiratory failure, or even sudden death.