Arthritis

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Rheumatoid Arthritis is among the most debilitating forms of arthritis causing joints to ache, throb and even deform over time. The exact cause of this inflammatory condition is not known, but it is believed to be caused by an attack on the synovium (tissue that lines the joints) by the body's immune system. The upper cervical spine can be damaged by the inflammation that is caused by rheumatoid arthritis. This disease is three times more common in women than in men and usually occurs between the ages of 20 and 50. Just like the gradual destruction of other joints in the body, several joints between the base of the skull and uppermost vertebral bodies in the cervical spine are very susceptible to damage from rheumatoid arthritis.

Symptoms

Some common symptoms of rheumatoid arthritis are pain and swelling in the smaller joints of your hands and feet, overall aching and stiffness, loss of motion in the affected joints, fatigue and low-grade fever. Small lumps, called rheumatoid nodules may appear on the skin of your elbow and on your feet and heels, though they usually aren't painful. The chances that the spine is damaged in someone with rheumatoid arthritis increase as they have the disease for a longer period of time. Studies show that people who have had rheumatoid arthritis for more than 10 years have at least a 60% chance of having some degree of cervical spine involvement.

The damage that rheumatoid arthritis does to the upper cervical spine usually cause the joints between the base of the skull and the uppermost vertebral bodies to become unstable. This can lead to three different, but characteristic deformities, or abnormal changes in the anatomy of the spine. The most common pattern of cervical spine instability in patients with rheumatoid arthritis is called alantoaxial instability. This results in an abnormal amount of motion between the first (C1) and second (C2) vertebral bodies. The second most common abnormal change caused by rheumatoid arthritis is called superior migration of the odontoid. The erosion of the joints between the base of the skull and the first and second vertebrae causes this to happen. As this process occurs, the tip of the odontoid begins to stick up into the base of skull. This can create pressure on the brain stem, which leads to problems with balance, coordination, and walking. The third most common spinal abnormality in rheumatoid arthritis is a condition known as subaxial subluxations, in which the lower vertebrae in the cervical spine begin to slip forward, causing the neck to develop a "hunched-over" posture.

Diagnosis

If you have had rheumatoid arthritis for a long period of time, you should have your spine evaluated by a doctor. This is because the chances of having abnormal changes in the cervical spine as a result of rheumatoid arthritis increase over time. Patients may not notice that their rheumatoid arthritis is affecting their spinal cord because this disease also causes arthritis in the fingers, hands, and hips at the same time. Arthritis in these joints can sometimes mask the symptoms of spinal cord compression from rheumatoid arthritis. People often blame their arthritic joints for the difficulty that they have in going up and down stairs, fastening buttons, or using the hands for delicate tasks. Sometimes, these problems are actually caused by rheumatoid arthritis of the cervical spine instead. If you have rheumatoid arthritis and you now have difficulty with the use of your hands or you are feeling unsteady on your feet, this is a definite sign that you should talk to your doctor about how your spine may be affected by this disease.