Rheumatoid arthritis (RA) is most commonly thought of as a disease of the joints, like osteoarthritis, but it is much more than that. RA is an autoimmune disease that can damage body organs in addition to the joints. Among the many problems caused by RA, some of the most dangerous are the neurological complications.
There are three primary neurological problems associated with RA. The most important and potentially dangerous issue is related to cervical spine or neck inflammation. Over time the inflammation from RA degrades the ligaments that help hold the neck vertebrae in place. In particular, the top two vertebrae can slip a little out of place and put pressure on the spine or even the brain stem.
Some cervical spine complications are potentially life threatening, so many rheumatologists include physical and focused neurologic exams as well as annual neck x-rays. Once the neck bones slide a little out of place, they can put pressure on the spinal cord causing numbness, tingling, weakness and pain in the arms or entire body, along with severe headaches.
If you have these neck problems, you will have neurological symptoms that may start gradually. Once it is determined that your neck is not stable, surgery is a probability. Walking around with an unstable neck can be life threatening. If surgery is required, it is likely to be a cervical fusion. This artificially connects neighboring vertebrae to each other, fusing them into one stable section of the spine to take pressure off the spinal cord and prevent permanent damage.
The second and much more common RA related neurological issue is entrapment neuropathy. This can take several forms, and may come and go with swelling and inflammation. For example, carpal tunnel syndrome is a problem for many RA patients because swelling and inflammation in the wrists put pressure on the radial nerves. Many times a steroid injection, splinting and occupational therapy can help bring some relief.
Obviously keeping the RA itself under tight control is paramount, but not always an achievable goal.
Some people experience sensory peripheral neuropathy. This is characterized by tingling, aching, and burning sensations, most commonly in the feet and legs below the knees. Typically this type of neuropathy does not affect function, so it is very uncomfortable for the sufferer but does not have obvious outward signs. Sometimes rheumatologists order electromyograms (EMGs) on a regular schedule to watch for this problem. It is usually treated by medication, often anti-convulsants that also work to decrease nerve pain.
Rheumatoid arthritis is not ordinarily thought of as a neurologic disease, but it can lead to neurological complications. Close partnership with your rheumatologist is the best way to be sure these issues are treated as they arise.
Sources:
The Johns Hopkins Arthritis Center
The Merck Manual, Seventeenth Edition, Centennial Edition.