Rheumatoid arthritis

What is it?

Rheumatoid arthritis is a chronic inflammatory autoimmune condition, when the immune system mistakenly targets and attacks the body’s tissues, which results in chronic inflammation that causes damage to various tissues in the body. The spine is often targeted, typically in the cervical region, which may cause two main types of abnormalities in the cervical spine:

  • Atlantoaxial instability is the common abnormality seen in rheumatoid arthritis. The atlantoaxial joint is the joint between the first two cervical bones or vertebrae, called atlas and axis. This abnormality results in the misalignment of those two cervical vertebrae.
  • Subaxial subluxation that results in compression of the spinal cord.

Symptoms

The symptoms of rheumatoid arthritis of the cervical spine may vary depending on the type and severity of the abnormality caused, and may include neck pain, neck stiffness, dizziness, facial pain, weakness or numbness in the legs and arms, difficulty walking, and difficulty swallowing.

Diagnosis

Doctors usually diagnose rheumatoid arthritis based on detailed medical history of patients, and physical examination including blood tests, X-rays, CT scans, and MRI.  

Treatment

Treatment is mainly focused on preventing serious complications. Most patients may be managed with conservative treatment which generally include taking medications such as nonsteroidal anti-inflammatory drug, corticosteroids, and antirheumatic drugs. The other non-surgical treatments include wearing the cervical collar and physical therapy.

Surgery may help relieve pressure on the nerves, brain, or spinal cord, and to provide spinal stabilization in people with rheumatoid arthritis. Different spinal surgical procedures are used:

  • Spinal Fusion is surgical procedure that may be used to correct spinal deformity and to provide permanent stability to the spinal column.
  • Spine stabilization by fusion is a surgical procedure where a bone graft is used to create an environment for the bones in the spine to fuse together over time, thus stopping the movement between the vertebrae and providing long-term stability.