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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.
Add a Comment6 Comments
Hello! I have been seeing a rheumatologist for approximatley 1 1/2 years now. We were both convinced there was a major inflammatory process going on. He has already diagnosed me w/fibromyalgia, connective tissue disorder and osteoarthritis. He knew there was arthritic activity but was falling short of calling it RA. He's a wonderful dr who truly listens to his patients and did not want to "rubber stamp" the condition due to it having such "permanency". My ANA was elevated but my rheumatoid factor was negative. I should probably also mention I had a very serious case of Lyme disease which warranted implantation of a pacemaker due to multiple episodes of Lyme Carditis and 7 varying degrees of heart block. Anyway, my primary physician asked me to confirm I was definitively diagnosed w/ RA because I have been receiving Humira for approx 6 months. My rheumy performed a blood test called Vectra testing (it tests multiple facets of your DNA for rheumatoid specific points). That testing came back extremely positive and he says it defintively provides the diagnosis of RA (since my symptomology was more vague). I keep using the word "definitive" because, as I'm sure you've been through, there's a lot of "maybe's" and "could be"s, etc. The main intent of Vectra is an objective measure to ensure current treatment is effective. However, it's also good because it shows DNA activity only in those affected by RA. The testing is expensive. However, the company will pay for any of your out of pocket costs over insurance. Even though I suspeted the diagnosis, I was torn between being glad that at least I know what it was and sad because I know the disfiguring pain my aunt went through. Now, I've decided that since I've been living with it for at least 5 years already (1 1/2 actually being treated), my treatment is already showing improvement in that my continuous pain is less intense and more sporadic. I really hope people really understand it does take patience when dealing with this and there are many people who would like to share experiences to help alleviate the stress. Thanks for letting me bug out for a sec there. Feel well!
January 25, 2012 - 8:36pmThis Comment
I am a 45 year old male that has suffered for a few years now with swelling of the wrists and ankles... I did break my left wrist twice and my left ankle twice whilst playing sports, but the symptons now effect my right limbs too.... The problems start with pain, followed by prolonged periods of swelling (in excess of 6 weeks) and gradually the problem subsides. I am currently experiencing a quite nasty episode of this condition that has lasted for 4 weeks now in my right wrist, and is starting to develop in my left ankle... I have been treated with 5 different types of medication from painkillers to anti-inflamitary to gout to RA and nothing has worked... I am working with a Rheumatoligist in Toronto, but nothing appears to be working... His solution is sit, rest and watch Soap Operas... This does not help with my condition and I find it rather hisheartening.... I just want to get better! Any Ideas? It is seriously effecting my work as well...
My problems include: pain, swelling, lack of strength, no radial or up and down movement and now immobility.
PLEASE HELP!!!
December 17, 2010 - 11:45amThis Comment
I think your dr is correct.
In such injuries best option is as much rest as possible
Till you heal completely. Medication usually doesn't
Work. It's like we r sick with fever and instead
Of resting we take medicine and start working .
I have been treating my neck injury from last 1 year
November 2, 2014 - 6:22amI see it is improving when I am resting like 10-12 hours
A day. Light stretching exercises help. Also u may want to
Do some cold and hot therapy.
I could do this all as I am on long term medical leave
Of absence.
This Comment
Thanks, Cary! I do see a rheumatologist, she has me on 100mg Pristiq for pain managment and I have the occasional trigger point injection. She really hasn't put a name on anything yet...I've been seeing her for 6 months or so..I may throw the polymyalgia dx at her to see what she thinks...I've tested negative for RA and Lymes disease, but I guess with the PMR you would test negative anyhow. Thanks again! Sue
April 18, 2010 - 8:03amThis Comment
Hi Sue-
Isn't it frustrating? It took years to get my RA diagnosis, and that isn't uncommon with these types of problems. Have you seen a rheumatologist? That would be the doc to see for fibro and PMR.
PMR can cause neuro complications because it can cause giant cell arteritis. https://www.empowher.com/media/reference/polymyalgia-rheumatica-and-giant-cell-arteritis Arteries can become inflamed and swollen, and depending on the artery, that can have an effect on nerve function. I don't think PMR would have caused the c5-6 bulging, but it can certainly cause the other issues.
If you haven't seen a good rheumatologist, you really should. That can be the secret to getting a diagnosis and proper treatment.
Good luck!
April 18, 2010 - 6:15amThis Comment
I'm curious to know if Polymyalgia Rheumatica has similar neuro symptoms as this? I don't have a diagnosis yet, and most of my symptoms are confined to the upper extremeties with some c5-c6 disk bulging. I have been to several different doctors and am seeing a neurologist next. I've had every diagnosis from fibromyalgia, myofascial pain syndrome, trigger points, you name it, but still no solid diagnosis...I also think it might stem from a six month use of a statin drug for my cholesterol (I have since stopped it). Any thoughts anyone? Thanks, Sue M
April 17, 2010 - 6:14amThis Comment