For reasons not completely understood, rheumatoid arthritis (RA) usually affects the cervical (neck) spine. Rarely is the disease found in the thoracolumbar (mid and low back) regions. It is more common in adult women and is characterized by 2 or more swollen and inflamed joints. Neck symptoms may include headache, neck pain, numbness, tingling, and weakness in the arms and legs.

Treatment may include:

First line/fast-acting drugs such as: Aspirin, naproxen, corticosteroids

Second line/slow acting drugs such as:

• Methotrexate, hydroxycholoroquine (Plaquenil)*
   
• TNF-blockers** such as Etanercept (Enbrel) and adalimumab (Humira)
   
• Immunosuppressants such as Azathioprine (Imuran), Cyclosporine (Sandimmune, Neoral)

*These are DMARDs or disease-modifying anti-rheumatic drugs. DMARDs help to prevent progressive joint destruction by promoting remission.

**TNF-blocking drugs may help block a protein that can cause inflammation (Tumor Necrosis Factor).

Physical therapy, therapeutic exercise - proceed as tolerated
Passive physical therapies such as range of motion are helpful. While active exercise is good, it should not be performed to the point of fatigue. In general, exercise helps to increase flexibility and build strength and endurance. During physical therapy, patients are taught how to protect their joints.

Periodic rest during periods of acute pain and after exercise can help to reduce inflammation.

Spinal Inflammatory Arthritis Glossary