Rheumatoid Arthritis (RA) is a common condition affecting the joints of the human body. RA is an auto-immune condition, meaning the body’s natural defence system attacks itself after mistaking a perceived threat. In RA specifically, the body attacks the synovial membranes (lining) of the joints, which secrete the lubricating fluid to reduce friction during movement. Most commonly RA attacks the small joints, especially in the hands and feet. Less well known is the second most commonly affected area, the cervical spine or neck.
Quick facts on RA
- It has a slow onset, usually weeks to months
- Usually affects joints on both sides of the body
- It is a progressive condition
- It affects 2% of Australians
- Onset is usually between the ages of 35 and 64
- Slightly higher proportion of females are affected over males
- You are more likely to develop if you are a smoker
- You are more likely to have cardiovascular disease, mental health issues, asthma, diabetes, COPD and cancer when you have RA
RA and the Neck
If two percent of Australians have RA, then 50% of these will have it in their neck. That’s around 250,000 Australians, a little larger than the population of Hobart, with this condition. Unfortunately, it is usually the worst cases that develop RA in the neck.
What actually happens?
The cause remains unknown however researchers believe there are genetic, environmental and immunological factors. These factors cause the distribution of genetic markers in the body which are detected by our bodies defence cells known as T cells. T cells are like a military scout, their job is to alert the lymphocytes which produce antibodies, you could liken a lymphocyte to a factory with the sole purpose of creating antibodies which flag the dangerous foreign invader, however in this case it is our non-threatening synovial membrane of the joint. Antibody production causes inflammation at the affected joints leading to heat, swelling, redness and pain.
The T cells also stimulate macrophages, another type of defence cell, more likened to a foot soldier. The macrophages normally attack foreign invaders like bacteria, however they also attack things marked with an antibody. The battlefield formerly known as a healthy joint undergoes protein breakdown causing ligaments and cartilage to become damaged leading to lax/loose ligaments. While this is happening the cells which maintain a health equilibrium between bone building and bone breakdown fall out of sync and we end up breaking down more bone than we build leading to weakness in bones.
Implications for the Neck
The neck is a sturdy structure normally, however in RA with less bone density, more ligament laxity, and changes to the cartilage, we become more prone to fracture, subluxation, and nerve entrapment. As you could guess, cracking or manipulating a RA neck is out of the question.
The priority for treatment is centred around maintaining muscle strength. The more control we have in the neck the better. Your Physio will create supervised program to rebuild neck musculature.
Pharmacological advancements have meant we can stem the progression of this disease, a consult with your Rheumatologist with help decide which medication is right for you.
If you have any questions about how to help manage your neck RA come in and speak to one of our experienced Spinal Physio’s at Bend + Mend in Sydney’s CBD.