Rheumatoid (room-a-toyd) arthritis or RA is a disease that affects all of the synovial (sin-o-vee-al) joints in the body including the spine. For people with RA, the effects of the arthritis on the spine can vary from minimal symptoms to life-threatening pressure on the spinal cord that requires complicated surgery to stabilize the spine and reduce the pressure on the spinal cord.
RA destroys synovial joints. As the joints are destroyed, the connection between each vertebra becomes unstable. The damage allows the upper vertebra to slide forward on top of the lower vertebra in the joint. This slippage is called spondylolisthesis (spon-dil-low-liss-the-sis). Spondolisthesis can cause pain due to pressure applied by the slipped vertebra on the nerve roots and the spinal cord. The problem of joint instability is very serious when it occurs between the C1 and C2 vertebrae in the cervical spine.
RA in the spine causes a wide range of symptoms. Pain is the earliest symptom and may be part of the overall joint inflammation that occurs with the arthritis. As the disease progresses, the symptoms that are most worrisome are those that suggest your spinal cord is being affected.
Pain at the base of the skull is common when the cervical spine is affected by RA, and can indicate that the nerves that exit the skull and the upper spine are being irritated or compressed. Pressure on the vertebral arteries can lead to blackout spells when the blood flow through these arteries is reduced when you move your head and neck a certain way.
A change in the ability to walk can signal increasing pressure on your spinal cord. Your gait (the way you walk) may become irregular, and may be accompanied by weakness and problems keeping your balance. This is an indication that your spinal cord is being compressed. Any change in the ability to walk should be brought to the attention of your doctor. Feelings of tingling, weakness, or a loss of coordination can affect the arms or legs. Changes in bowel or bladder control such as incontinence or inability to urinate can also occur.