Rheumatoid arthritis can affect the first and second vertebrae in the neck. This can cause pain, stiffness, and spinal instability.

Rheumatoid arthritis (RA) can start in the smaller joints of your hands and feet. As the disease progresses, however, it can spread to other parts of your body, like the neck. This doesn’t typically happen until years after the onset of arthritis symptoms.

This article discusses the causes, symptoms, and treatments for RA in the neck.

RA can cause synovitis in the joint between the C1 and C2 vertebrae. Synovitis is inflammation of synovial connective tissue within a joint.

The C1 vertebrae, also known as the atlas, supports the weight of your head, and the C2, or axis, helps your neck move in different directions. This is the only joint in the neck with a synovial lining.

Chronic inflammation in synovial tissue can lead to bone and ligament destruction within a joint.

An unstable vertebra can shift or dislocate over time. This increased movement can put pressure on the spinal cord and nerve roots.

Neck pain is a primary symptom of RA in the neck. The severity of neck pain varies from person to person. You may feel a dull or throbbing ache in the back of your neck around the base of the skull. Joint swelling and stiffness can also make it difficult to move your head from side to side.

The difference between RA neck pain and a neck injury is that stiffness and pain from an injury may gradually improve over days or weeks. Without treatment, RA can actually worsen. Even if symptoms improve, inflammation, swelling, and stiffness can return.

RA in the neck also differs from osteoarthritis. RA pain is due to inflammation in the joints, whereas osteoarthritis involves the natural wear and tear of joints.

Headaches can also occur with RA in the neck. These are secondary-type headaches that involve the first and second vertebrae. These types of headaches are also called cervicogenic headaches. There are spinal nerves on both sides of these vertebrae, and these nerves supply feeling to the scalp.

Cervinogenic headaches can mimic a migraine, cluster headaches, and other types of headaches. However, while some headaches originate in the forehead, brain, or temple, a headache caused by RA originates in the neck and is felt in the head.

These headaches can be one-sided and worsen with certain neck or head movements.

RA in the neck doesn’t only cause pain, stiffness, and headaches. The area around your neck may also feel warm to the touch or appear discolored.

Other symptoms can develop if your vertebrae press on the spinal cord and nerve roots. Spinal cord compression can reduce blood flow to the vertebral arteries in your neck, and it may reduce the amount of oxygen that travels to your brain. This can lead to dizziness and even blackouts.

When this happens, you may have numbness and tingling around the neck that radiates up the back of the head. This is in addition to joint pain, stiffness, and swelling. Spinal cord compression can also affect balance and walking and cause bowel and bladder control problems.

RA can cause other symptoms, too. For example:

A physical exam can help your doctor gauge the range of motion in your neck, revealing signs of joint instability, inflammation, and misalignment.

There isn’t a single test to diagnose RA, but your doctor may order a series of tests to reach this conclusion. This includes blood work to look for inflammatory markers and auto-antibodies that often indicate RA. You may also undergo an imaging test that takes pictures of the inside of your body, such as an X-ray, MRI, or ultrasound.

These tests help determine the extent of the inflammation and joint damage in the neck.

RA in the neck can progress and cause permanent joint damage. There’s no cure, but a combination of therapies can help improve symptoms and reduce inflammation.

Medication

In mild cases, over-the-counter and prescription medication can help stop joint inflammation and pain, and slow the progression of the disease.

However, doctors often recommend prescription medications to treat RA pain. Options include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help mild to moderate pain. These include ibuprofen (Motrin) and naproxen sodium (Aleve). If these don’t provide relief, your doctor can prescribe a stronger anti-inflammatory or a corticosteroid like prednisone.
  • disease-modifying anti-rheumatic drugs (DMARDs): DMARDs slow the inflammation from RA. These include medications like methotrexate (Trexall, Otrexup), tofacitinib (Xeljanz), and leflunomide (Arava).
  • biologics: Biologics are a type of DMARD that are highly effective at treating inflammation. There are numerous biologic therapies; your doctor will assess which is right for you.

Therapy

Since inactivity can worsen joint pain, your doctor may recommend light exercise to reduce inflammation and improve strength and flexibility.

Start slow and gradually increase the intensity of workouts to determine what you can handle. Your doctor may also recommend massage therapy to reduce stiffness and pain in the joints around your neck or physical therapy to improve your range of motion. Swimming or water aerobics may also be helpful for RA, especially when they’re in a heated pool.

Sleeping on a therapeutic pillow may help to better support your neck and head. This can keep your neck in proper alignment while sleeping, helping reduce pain and stiffness.

Using a hot or cold compress for about 10 minutes may also help reduce inflammation, stiffness, and swelling.

Surgery

If you have severe, permanent joint damage or signs of nerve compression, your doctor may consider a may consider a cervical spine procedure. Surgery can include spinal fusion, which helps restabilize the first and second vertebrae, or you may need a procedure to remove pressure from the spinal cord compression.

Surgery can also remove any bone spurs or inflamed tissue in the neck.

See a doctor for neck pain that’s persistent, doesn’t respond to home remedies, or interferes with daily activities, especially if you already have a diagnosis of RA. You should also contact your doctor for neck pain accompanied by:

A proper diagnosis and treatment can reduce inflammation, slow the progression of the disease, and improve your quality of life.

RA is a chronic, progressive disease that can worsen. Chronic inflammation can lead to permanent joint damage in the neck, and untreated RA can gradually affect other parts of your body. Talk with your doctor to determine which treatment option is right for you.