Cervical involvement in rheumatoid arthritis

Mechanism and manifestations

It may be minimally painful or cause neck and occipital pain and cord symptoms. Other levels may be involved, and vertical upper cervical displacement can occur.

Diagnosis and management

Imaging and rheumatology or spine assessment evaluate inflammation and stability. Disease-modifying treatment, monitoring or surgery depends on findings. Cervical manipulation and traction should not be offered until instability has been excluded.

Points to consider

Infection and inflammatory disease require different treatments. Fever, immunosuppression, infection history, unusual pain and neurological deficits influence urgency. Absence of fever does not exclude infection. Physical modalities must not delay necessary medical investigation.

Role of TAGMED care

This condition first requires medical diagnosis and, depending on the situation, specialist management. TAGMED services do not replace treatment of infection or tumor, stabilization of an unstable injury, or neurological or vascular treatment. Any conservative support should be considered only after diagnosis, restrictions and the treating team’s recommendations have been clarified.

Related concepts and distinctions

These concepts belong to the same field, but are not synonyms.

• Septic facet joint arthritis — Infection of a vertebral facet joint that may spread into paraspinal tissues or the epidural space.
• Non-radiographic axial spondyloarthritis — Form of axial spondyloarthritis without sacroiliitis meeting conventional radiographic criteria despite a compatible clinical context.
• Spinal tuberculosis — Spinal infection caused by Mycobacterium tuberculosis, potentially destroying vertebrae and causing abscess, deformity or neurological compression.

Medical references

1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid Arthritis.
2. AO Foundation. AO Surgery Reference — Occipitocervical trauma.

References document the topic; their inclusion does not imply endorsement of TAGMED services by those organizations.