Rheumatoid arthritis (RA) is a chronic inflammatory disease where the body’s immune system mistakenly attacks the lining of the joints. An overactive immune system causes an inflammatory response, resulting in symptoms, such as pain, swelling, and stiffness.

Rheumatoid arthritis 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.

Chronic inflammation in the neck causes the destruction of the synovial joints, which are the joints that allow movement. When arthritis damages this joint in the neck, the cervical spine can become unstable.

Vertebrae are small bones that form the backbone. There are seven, and rheumatoid arthritis typically affects the first and second, called the atlas and axis, respectively.

The atlas supports the weight of your head and the axis helps your neck move in different directions.

An unstable vertebra can shift or dislocate over time and eventually press on the spinal cord and nerve roots. 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.

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. If left untreated, RA in the neck may not get better — it can actually worsen. Even if symptoms do 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.

Osteoarthritis can also affect the neck. However, pain and stiffness with RA can be worse in the mornings or after periods of inactivity. Osteoarthritis neck pain tends to worsen with activity.

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

These types of headaches are also called cervicogenic headache. They can mimic a migraine, cluster headache, and other types of headaches. But 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 slightly red.

Other symptoms can develop if your vertebrae press on the spinal cord and nerve roots. 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.

Spinal cord compression can also affect balance and walking, and cause problems with bowel and bladder control.

RA can cause other symptoms, too. For example:

  • lack of energy
  • fever
  • flu-like symptoms
  • loss of appetite
  • weight loss
  • difficulty sleeping
  • brain fog
  • hard bumps or tissue under your skin

A physical exam can help your doctor gauge the range of motion in your neck, and it can reveal 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 are often indicative of RA. You may also undergo an imaging test which takes picture of the inside of your body, such as an X-ray, MRI, or an ultrasound.

These tests are helpful for determining the extent of 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.

1. Medication

Over-the-counter and prescription medication can help stop joint inflammation and pain, and slow the progression of the disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for 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.

Your doctor may also include disease modifying anti-rheumatic drugs (DMARDs) as part of your treatment. These include medications like methotrexate (Trexall, Otrexup), tofacitinib (Xeljanz), and leflunomide (Arava). Or, you might be a candidate for a newer class of DMARDs known as biologics. These drugs target the part of your immune system that causes inflammation.

You can take DMARDs alone or combine it with other medications.

2. Therapy

Since inactivity can worsen joint pain, your doctor may recommend light exercise to reduce inflammation and improve strength and flexibility. This can include activities that don’t involve a lot of neck movement such as walking or biking.

Start off 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 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 provide your neck and head with better support. 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.

3. Surgery

If you have severe, permanent joint damage or signs of nerve compression, your doctor 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:

  • tingling
  • numbness
  • headache
  • pain that radiates down your arm

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.