Neck involvement

Painful and restricted neck movements may occur in moderate and severe rheumatoid disease. In moderate disease involvement of the neck may occur with pain and restriction of neck movements.

In severe disease, these characteristics may be accompanied by neurological features in the arms, such as pins and needles and muscle weakness or wasting, making any existing problems with upper limb function worse.

In long standing Rheumatoid Arthritis (RA), the joint linings (synovium) of the upper cervical vertebrae may become inflamed. This inflammation (synovitis) damages the ligaments and the bony structure of the vertebrae in the neck. This leads to instability of a vital joint where the skull pivots on top of the vertebral column (the atlanto-axial joint). Instability of this joint may lead to slippage of the skull so that the spinal cord becomes compressed at the point where it leaves the skull. Compression of the cord at this high level often results in paraesthesia (numbness, pins and needles) in both arms with loss of feeling, reduced reflexes and reduced muscular power. This leads to loss of grip and manual dexterity. All upper limb activities may be adversely and significantly affected.

Lower limb problems may occur in long standing RA where compression of the spinal cord in the neck is present. Weakness of the leg muscles occurs with reduced reflexes and pins and needles.