Q: Mother has been complaining about neck pain and stiffness for the last couple of months. She has been diagnosed with rheumatoid arthritis but it's only in her hands. Is it possible these new symptoms could be from the arthritis, too?

A: Although rheumatoid arthritis (RA) seems to target the small joints of the hands and feet, in fact, it can affect any joint in the body, including the cervical spine (neck).

Head, neck, and/or arm pain with or without numbness and tingling of the arms and/or hands can signal arthritis of the neck. There could be an electric shock sensation (called Lhermitte sign) down the arms if there is pressure on the spinal cord.

Muscle weakness and atrophy are further neurological signs observed with this problem. Anyone with RA who develops new symptoms of this type should report this change to his or her physician. These are potentially early signs and symptoms of degenerative changes in the cervical spine that could lead to serious instability.

Cervical spine instability is defined as movement, translation, or "slippage" of one cervical vertebra over the vertebra below it. Two other words used to describe this problem are translation and subluxation.

To form a true subluxation (partial dislocation), the vertebra has to slide at least two millimeters (as measured on X-rays). This measurement refers to the reducible difference. In other words, when the bone is shifted and lined up as much as possible, there is still at least two millimeters of displacement. The shift can be in any direction (forward, backward, rotation, sideways). Most of the time, the displacement is anterior or forward.

An X-ray is needed to confirm the diagnosis. The physician will perform a clinical examination and perform some tests of neck motion, arm strength, and screen for neurologic involvement.

Early diagnosis and treatment is best for problems like this so don't delay. Make an appointment at your earliest convenience. There may be nothing to it but even that information will provide a measure of comfort and reassurance.

Reference: Takashi Yurube MD, et al. Progression of Cervical Spine Instabilities in Rheumatoid Arthritis. In Spine. April 15, 2011. Vol. 36. No. 8. Pp. 647-653.