Can Rheumatoid Arthritis Affect the Spine? | Rheumatoid Arthritis Warrior

Can Rheumatoid Arthritis Affect the Spine?

neck xray

You can’t get Rheumatoid Arthritis in the spine, can you?

(The funny noises in my neck say yes. Let’s see what the funny-sounding medical words say about RA in the spine…)

The only books on Rheumatoid Arthritis that I read are ones from “legitimate” sources such as recognized university hospitals or M.D.’s who specialize in rheumatology. But, there has been a problem: the experts often disagree.

A chief area of disagreement is which joints that can be affected by Rheumatoid Arthritis. Most authors include their list. However, the different lists do not match one another or the facts that I have learned firsthand.

Rheumatoid Arthritis in the spine is one prominent example. I have read several lists which exclude the spine. I have also talked to doctors who believe that the spine cannot be affected by Rheumatoid Arthritis.

I am only reporting the RA spine facts as I read them

Well, I don’t imagine that I am equipped to argue with experts. All that I can do is report the facts as I learn them. Here are some facts about Rheumatoid Arthritis in the spine.

The doctors who write a site called Spine Universe describe in detail the manner in which RA affects spinal joints. They say that the neck is usually the first area of the spine to be attacked by RA. An excellent illustration accompanies their clear description of Rheumatoid Arthritis in the cervical spine.

Let me quote to you a report from WebMD’s emedicine since I cannot say it any more clearly myself:

RA activity in the cervical spine begins early, with 83% of patients in prospective studies developing anterior atlantoaxial subluxation within 2 years of disease onset. Activity in the cervical spine progresses clinically and radiologically in tandem with the peripheral-joint involvement. In fact, the severity of the peripheral erosive damage is strongly correlated with the degree of structural damage in the cervical spine.”

83% of people with RA have involvement in the atlantoaxial joint within 2 years. The atlantoaxial joint is between the first and second vertebrae in the neck: C-1 and C-2. That is the joint which caused the predicament of Nicole Bradshaw that I reported here last week.

Joints in the spine affected by Rheumatoid Arthritis become unstable. Damage to supporting tissues can cause vertebrae to slip in a process called spondolisthesis. The result can be pain due to pressure on nerves caused by the slipped vertebra. The spinal cord can be compressed which can cause a wide range of symptoms.

Although it is more common in the cervical spine, the thoracic and lumbar spine can also be affected by Rheumatoid Arthritis. It is not too difficult to find examples of this in medical journals. After one study, the Journal of Bone and Joint Surgery stated, “We submit that subcervical rheumatoid spondylitis is commoner than is generally believed, though less common than rheumatoid involvement of the cervical spine.”

Question: Why can I find this information with just a few hours of research when some M.D.’s are confused about it? Is it because I have no prejudice against the existence of Rheumatoid Arthritis in the spine? Thank God for RA in my spine, I guess, which enables me to shine the light on the truth.

Check out this essential little book about RA and the spine: Death by Rheumatoid Arthritis: Possible and Preventable

Read more about how RA affects the spine!

Recommended reading:

Edited: Mar 22, 2017, to update a link that had changed.

Kelly O'Neill

Kelly O'Neill (formerly Kelly Young) has worked about 12 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over fourteen years with unrelenting RD. See also https:/

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102 thoughts on “Can Rheumatoid Arthritis Affect the Spine?

  • June 1, 2013 at 7:40 pm

    My spinal involvement started very low in my back, really in my SI joints. I know those aren’t technically my spine, however, during recent flares, the pain advanced up my spine to the midpoint of my back. Sharp, stabbing pain directly on the spine – it was terrifying.

    All of my other joints are involved, including odd ones at the edges of my ribs or sides of my feet that I didn’t know I even had until they started hurting.

    I’m not sure why docs would say it can’t happen in the spine. To me, just think about what this disease does – our immune systems become miscued to target our own tissue. If that type of tissue (our joints) exists in the spine, why *wouldn’t* spinal involvement happen eventually?

  • July 25, 2013 at 1:06 am

    Thanks so much for posting about the spine and RA. I often have neck pain that causes nausea and sometimes shooting pain in my shoulders/arms. It was so bad at one point that I didn’t move for days. I also often have severe pain in my lower back/butt and am wondering if it is RA related too. The pain radiates down into my thighs. It’s awful. Seems like a strong possibility it’s RA. On a separate but related note, thanks for posting about RA and the ribcage too. Recently, I have had off and on pain there too that left me in so much pain I was unable to even wear a bra! This is a frightening disease! I think I would be a mess without your website! Thanks for doing what you do! You’re a warrior and a hero!

  • October 20, 2013 at 8:30 pm

    I will be doing my first physical therapy tomorrow morning for my lower back pain. Of course, it can’t be from RA since my rheumy is adamant it only affects the hands and the feet. The statement you made Kelly about them looking at only the top of your hands made me chuckle (in a sad way) a little. I saw my rheumy last week and the only ‘exam’ she did was to look at the top of one hand and that was only because I mentioned it had been hurting more in the last couple of weeks. When she did my blood work, she didn’t even check my inflammation levels. Oh me…..
    I also wanted to ask if anyone else ever has problems with their eyes related to RD. I have been to my eye doctor and even went to see a specialist and guess what – there is ‘nothing’ wrong with my eyes. However I know better – just wondered if it has affected anyone else.
    Thank you again Kelly for all you do! We love you – keep up the good work.

    • October 20, 2013 at 9:22 pm

      Nancy, the eyes can be affected in various ways, but the most common is dryness or inflammation. Maybe you can ask them if you can come in to have them do a split lamp test on a day they are bothering you a lot. Or just try another eye doc for a 2nd opinion in case this one missed something.

  • October 23, 2014 at 7:26 pm

    I have RD of cervical,Thoratic and lumbosacral spine.I have had L-3 thru L-5 fused(spondylosisthesis L-5) RD in c-1 and c-2 fusion of c-3 thru c-7 (c-3 and c-4 severe compression of spinal cord I couldn’t hold a coffee cup or drive) I just had another ct scan due to shooting pain across my hips down back of thighs to the top of Knee T-12 L-1 bone to bone L-2 spondylosithesis causing pain issues.I was diagnosed with RA 5/2010 after years of eating Ibuprofen like jelly beans.They stopped working. Then I was walking across the backyard 7/2013 had a shooting pain in my legs and fell to the ground and the nerves in my back and legs would not let me walk so to the er then fusion l-3 thru l-5. I have also been diagnosed with RA of the SI joints My hands and feet swell and turn red and ache.I have trouble walking right! I am looking toward another fusion because lyrica and tramadol and flexaril aren’t working. Injections are out because i have glaucoma and the steroids would raise my eye pressures dangerously high. So to those who think that RD of the spine is not real; come look at my mri’s.ct scans and xrays.Oh and the occassional trip to gov’t buildings when I light up metal detectors like a pinball machine!
    But I must say that having RA/RD has made me a bit more compassionate and understanding of others. Other than my funny pequin walk I look like a “Normal Man”.But I cannot remember a day without pain. So to the nay sayers it does effect the spine! Sorry I talk to much .Thank you for your efforts and work for all of us who sit quietly and endure the pain and try to be normal.

  • December 5, 2014 at 1:03 am

    Thanks for those of you who commented on RA/RD involving the spine. It helps to validate that what I suspected was true and I’m not going nuts! I’m being told at a recent visit with a new Rheum that “RA of the c-spine is extremely rare” and “RA doesn’t affect the thoracic or L/S”. If there’s no inflammation in the spine, then why did my bone scan light up from my cervical, thoracic, and lumbar spine?
    I have documented on MRI, pre RD diagnosis (2012), of herniations at L3-L4 and L5-S1 with rupture at the L3-4. No history or trauma. They keep telling me this is all osteo. I asked to have a baseline X-ray of my c-spine but I’m being denied being told it’s not necessary unless I have symptoms. Well I was never asked if I had symptoms! I consider frequent neck pain with posterior headaches along with this weird vibrational noise in my left ear possible symptoms. Rheum says its only recommended before surgery. I’m also told by new Rheum that I couldn’t have had RD for as long as I think I’ve had it based on what I consider early symptoms because I should have bone erosions being visible on x-Rays by now if I’d had it this long (first joint symptoms, bilateral thumbs noted 2005). New Rheum says that it is probably osteo but this is confusing to me since the most recent hand xrays just little more than a year old said normal no signs of osteo??? I don’t know about that does anyone know how long one has to have RD before a bone erosion will show up on xrays? Thanks for letting me vent! Not a very good sign in my opinion of first visit to New Rheum!

  • December 17, 2014 at 7:16 pm

    I am a 58 yr. old male I have been dealing with various issues for several yrs. Among them are kidney infections repeatly, prostitus repeatly, back pain neck pain ,repeated bouts of weekness, diagnosed with fibromyalgia, last two things during my multiple hospital stays were positive RA factor, and last but not least mini stroke. I will be doing an MRI of my spine tomorrow, and then a heart cath. My grandfather died at age 58 with what was then called crippling arthritis it was an awful thing he died when I was young but I remember. RA is an insidious monster and is really not understood by medical field. I think I know what is wrong with back but hope chiropractor told me 2 yrs. ago your back is ate up with arthritis. Im glad I found this its good to know im not alone but for all your sakes I wish I was.

  • July 11, 2015 at 3:29 am

    The first symptoms from my RA presented in my lower spine and slowly worked it’s way up towards my neck, all the while, it started to effect my other joints. Because of the strange presentation, it took over 3 years, until my other joints had gotten so bad, to get a diagnosis.
    It’s definitely a disease that doesn’t come packed nicely in a box. It never looks the same.

  • August 22, 2015 at 1:33 pm

    I have had RD for the past 20+ years. It has progressives rapidly the last 10 years. Can you have RD in the spine? Absolutely. Mine is both cervical (C1,2,3,4) and lumbar . Much subluxation, spondolythesis, bulging disc from compressed vertebrae and pretty daily nerve related pain.
    RD of the spine poses some unique care concerns as it is so easily exacerbated.
    The ,sat 2 rheum jets to,d me that RA of the spine is non-existent. Boy are they wrong!

  • January 30, 2017 at 1:21 am

    Hello, I too have RA. I don’t think it’s in my spine, just guessing, but I don’t have pain there. But I sure get a bad stiff neck! I also get this nerve pain in my groin that goes down my legs. I also get the rib cage thing from time to time. Ive just resently ended up in a wheelchair due to my right leg will not straighten up because the knee is bent 80%. I might look into knee munipulation but it makes me cringe thinking of that process. Whew! So anyway I’ve had flare ups so bad that I letterally had to have my family help me lay there to pee (sorry if im too blunt) for at Least 3 or 4 days because I couldn’t move. They had to sit me up to sip Water. I started to noticed foods sat me off, so I tried really hard to listen to my body when I’d eat something that triggered it. I started writing everything down that I ate & drank & how I felt. It took time to figure it out, but I think I pretty much know now. Everybody is different. But I had to stop eating Gluten, all sugars, all dairy, processed foods, most grains, nightshade foods, acidic foods, coffee! Oh no not my coffee! But yes no coffee. Oh but I can drink green tea. It still gives me that pick up that gets me going in the morning but without the jitters & all that stuff. If I eat out I have to make darn sure there’s no hidden foods in what I’ve ordered. So as u all know life can be hard. It took a few weeks but I got better. I even forget to take my pain killers now from time to time. Plus I’m taking less. I seem to be feeling better & better. I guess it’s been 3 months now that I’ve got really stricked on what I put into my body. Boy do I miss ice cream! But all I have to do when I’m thinking of blowing it & giving in to my cravings is I think back of all that horrible pain. That does the trick for me. Plus I’m excited thinking of how good I can get. Maybe I’ll have a better chance of going into remission if Ive stopped aggravating my disease. Who knows. But what do I have to lose? My diet is so healthy that no matter what I know that has to be a good thing. I also started taking turmeric capsules daily as I’ve read lots of proven evidence that it reduces inflammation. I only eat organic. Grass feed meat & lots of veggies some fruits, eggs, some raw nuts. Just healthy natural things. Next month I go in to see my RA doctor so I’m really hoping my inflammation number will be down. It feels like it should be. Well anyway I have a few more health issues. I’m hoping that by getting this RA better that other things will heal as well. One day at a time. I never thought I could do this for 3 whole months. Who knows maybe a couple of years from now I could eat a little ice cream & it won’t hurt me. Oh…only natural organic ice cream. Tee hee hee. I wish u all strength, happiness, love & health.?

  • April 23, 2017 at 4:17 pm

    Thank you for posting this, I was diagnosed in June 2010 after 2 years of pain and swelling. I am seeing my second rheumatologist since then as well as gp. My current rheumy is very good but I have not brought up my neck and shoulder problems as not sure how he will respond. Thinking it might be time for a new rheumy who might help me more.

  • April 23, 2017 at 5:09 pm

    Rd has destroyed my spine. I had two cervical discs replaced in August. Every disc in my lumbar spine is herniated, ruptured and has bone spurs. I also have scoliosis 25 percent. Which I never had until Rd diagnosis. After 2 ablatuins of the c spine over 4 years my spinal Corfu was being compressed and I did not know until the pain came back, double edged sword. I now have horrible sciatica from l4 to 5. My spine management pain dr wants more ortho/neurosurgery. Never again. Seeing him next week. Be careful with ablation, it masks worsening symptoms. Your spinal column contains synovium down to l4/5.

  • April 23, 2017 at 6:51 pm

    Thank you sooo much for this article!! I know I have it in my neck and spine….but my Dr is absolutely denying it! Looks at my fingers and that’s it. So thankful for your info KellY!!

  • February 13, 2018 at 7:46 pm

    Oh my gosh I got diagnosed with rhuematoid arthiritus 15/16 years ago when I was 20 years old just 2 years ago it got severe
    My back was in agony more so after resting at night or first thing in morning after sleeping, sitting or standing too long but overall activity made the pain better !
    I was adamant I had rhuematoid in my spine I put this to my rheumatologist they said no such thing as rhuematoid in the spine !
    But when I googled rhuematoid arthiritus of the spine it came up ?
    I was so confused
    Just before Christmas I literally begged my rheumatologist for a MRI scan of my spine
    I got my results 2 days after Xmas by post I have degenerated joints of my neck along with 2 buldging discs ( this is why it hurts to turn my head left and right )
    I have a lot of long standing inflammation in the middle of my spine ( which causes a lot of pain) and sacrilitis and erosions of the bottom of my spine i do not have the bloods for ankolysing spondylitis ( but my children do ) hlab27 but because of the damage seen on MRI to my spine they diagnosed me with ankolysing spondylitis !! ( cousin to rhuematoid arthiritus )
    Had my appointment with my rheumatologist she explained I have 2 autoimmunity disorders the ankolysing spondylitis ( which is a type of spondyloatopathy ) and rhuematoid arthiritus
    I am a bit scared about the inflammation in my spine as its attacking it, over last 2 years had 3 shoulder ops as the inflammation had attacked my shoulder blade on right shoulder so badly it collapsed the other procedures on shoulders was to get the inflammation out
    I start an enbrel injection on Friday they told me it will help with pain in lower and middle back pain but not my neck !
    Bring it on anyway in a lot of pain done relief better than none

  • February 16, 2018 at 11:00 pm

    I’m very new to this, but when I saw a neurologist for muscle spasms and fasiculations he ordered a cspine MRI which revealed degenerative disc disease. Now, three months later, I just saw a rheumatologist because of positive anti-CCP and she believes it is likely RA though she doesn’t want to pigeon hole me yet as it might be another connective tissue autoimmune issue.

  • June 13, 2018 at 12:15 pm

    Good afternoon Kelly. I went to see a pain specialist yesterday…he told me there is no Synovium in the spine!…its only found in the kneck joints. I told him that that wasn’t true…he said “lets both agree to disagree on that point”. I’ve had lower spinal pain since I was a teenager. I first truly noticed it while working for a Bed and Breakfast. Bending over to make beds. The pain in my lower back would get stiff and painfull, and I’d have to slowly stand and straighten my back. I always thought it was from having a rather large chest for someone as thin as I was back then. After my breast reduction in 2009…my lower back pain has only gotten progressively worse..I cannot stand for too long or sit for too long before the stiffness and pain start up again. Sleeping on these painfilled night…constantly wake me. I was diagnosed in 2009, 3-4 months after my breast reduction….with a low possitive blood marker for RD. Since then no possitive anything. Three years after seeing that one Rheumatolgist whom diagnosed me with the RD came back and said my bloodwork was negstive and I no longer had RD…. No meds as my pain comes and goes and each day is a different painful surprise…the frustration I feel is beyond what anyone should ever have to go through.

  • June 21, 2018 at 3:01 am

    Thank you for your website and your articles Yes , I too have RA since 2014. I am 55 years old female.. started with my hands and feet and pain seemed all over. Finally got an answer .. I also agree., no one truly understands RA unless they walk in these shoes. Your website came across today as it almost 3 weeks from my surgery ! Yes RA is real and can affect your spine. I got the news on April 28 that my MRI showed my spinal cord was being compressed at C1 and C2 . I just had an infusion of Actemra and methotrexate and Hydroxyquine. We had to wait 39 days for my surgery. They kept checking in to make sure my symptoms were not increasing. I was in severe pain and horrified that I needed this surgery. On June 1, my surgery was performed by Rothman at Jefferson Hospital
    They had to decompress my spinal cord and stabilize it. Then they used titanium rods and screws and bone graft they did a posterior Cervical Thoracic Fusion
    C1-C7 and my thoracic at the T -1
    I was in the hospital 6 nights and seven days !! Most of the doctors and aides didn’t seem to realize or understand besides this extensive surgery I have had problems. The pain management team didn’t seem recognize my RA as I wasn’t on my meds for a month before I had my surgery…
    They actually only added . 5mg to my oxycodone every 4 hours if needed . What are they crazy??
    I am home doing well, so my spinal cord is safe . My entire cervical spine is fused together including thoracic T-1. I had no choice as it was already dangerous because the spinal cord compression. The surgery was approx 5 hours , I was in the recovery rm 5.5 hours. My poor hubby had to wait 10.5 hours to see me
    I tried to have this all in place for my surgery and it went right out the window.
    They chopped my hair and shaved the site for the surgery .
    I am scared as so many people don’t understand RA
    I just wanted to reach out to anyone trying to figure out if the surgery is the right course . My surgeon, thought I was nuts as my daughter will be a senior .. I asked if I could wait and he said are you kidding me!
    He explained time is the essence! Any change with symptoms to call him and we would have to weigh the options. The surgery went well
    I hope this info helps💕
    I feel like a burden to my family and I found a therapist that I met before the surgery and will be seeing her on in a week. It has been 2 weeks I am home, my husband took off the first week .. , I am seeing it take a toll on him
    RA effects the entire structure at home. My dogs get it .. I have 4 large dogs and they seem to get it about RA!!
    Feel free to contact me denisedonlon@yahoo.,com

  • July 12, 2018 at 9:30 am

    I 💯 agree with spine and neck RA! The neck was one of the first areas that I was having issues with… when in my mid 40’s. Then all othe other joints started with pain, hips, fingers and feet. The neck pain has returned. After 20 years I am having neck issues again worst than before.

  • December 18, 2018 at 11:13 pm

    I have just gone Thur a work up on my neck.Primary and Radiologist read as Rx of c3 and c4.Spinal drssid it was because the arthritis gas eroded the carlidge do I am running bone on bone.I knew that,I can hear it.
    The inject to c1 c2 was very painful and did no good. surgery isn’t in the picture because if the amount of. Cervical spine in volved.Any use of my arms for long periods of time is very painful!


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