It’s common knowledge that rheumatoid arthritis (RA) affects the joints in the hands, arms, and legs. But did you know that RA inflammation can affect your jaws and your larynx? There are four joints in your body that are rarely mentioned. It’s important to know about these joints so you can recognize symptoms that they may be affected and speak to your rheumatologist about addressing the issue.
Your spine has joints in two places, the top and the bottom. The atlantoaxial joint is located at the very top of your spine, between the C1 and C2 vertebrae. This joint is involved when you move your head and research indicates that it is quite common for it to be affected by RA. Studies found that “83 percent of patients in prospective studies developing anterior atlantoaxial subluxation within two years of disease onset.” Anterior atlantoaxial subluxation means difficulty in movements that involve a rotation of the neck.
RA in your neck can be one of the potentially scary effects of the disease. It can cause instability between the C1 and C2 vertebrae, which can affect the spinal cord. People who have severe RA in the neck joint can have surgery to have the joint fused, which solves the problem. Symptoms of such neck involvement can include pain and stiffness of the neck, particularly where the spine attaches to the skull. As well, you may experience neurological symptoms, such as numbness, weakness and tingling in your arms, headaches, loss of balance, and popping or grinding sounds in your neck. Please talk to your rheumatologist if you have such symptoms.
RA inflammation can affect the temporomandibular joint or jaw joint. Your bottom jaw attaches to your skull on both sides of your face, by the ears. If you put your fingers right in front of your earlobe and open and close your mouth, you’ll feel the joint move. If your jaw hurts when you open your mouth to, brush your teeth, chew your food, yawn, or it hurts at the dentist, your RA may be affecting this joint. RA inflammation and damage in your jaw can also lead to a diagnosis of temporomandibular joint disorder, or TMJ.
When your jaw hurts, there are a number of things you can do to ease the pain. In addition to taking painkillers, applying a hot, damp washcloth to the sides of your face where the jaw joint is located can help relax the muscles that may be contributing to the pain.
When you eat, think soft food instead of hard and crunchy, and avoid food that requires you to open your mouth wide, such as burgers and apples. This doesn’t mean you have to give up this kind of food. Cut it in smaller pieces or in the case of burgers, eat the patty and the bun separately. You may also want to talk to your dentist about getting a mouthguard, which prevents you from clenching or grinding your teeth at night.
Has your voice changed since you got RA? Are you more hoarse, or do you get laryngitis unrelated to colds? Does it feel like there is a lump in your throat, or do you have trouble breathing? If so, you may have laryngeal manifestations of RA. And you’re not alone. One study found that among people who have RA, half had these kinds of symptoms.
The joint involved is called the cricoarytenoid joint. It’s located between two types of cartilages in the back wall of the larynx and is involved in opening, closing, and tightening your vocal cords when you speak or breathe.
Treatment includes oral steroids, as well as steroid shots directly into the joint. If the joint is severely affected and interferes with the person’s breathing, surgery may be necessary.
The other joint in your spine is the sacroiliac or SI joint. It is located at the bottom of your spine, connecting it to the sacrum and the pelvis. There appears to be some controversy about whether RA can affect the SI joint. Some sources indicate that RA can be a source of SI joint inflammation. However, others suggest that SI joint involvement actually is one of the factors that differentiates RA from other types of inflammatory arthritis, such as psoriatic arthritis and spondylitis. Furthermore, one study suggested that issues with the SI joint in people with RA does not differ from for instance, that found in individuals with osteoarthritis.
When your SI joint is affected it is, quite literally, a pain in the butt, concentrating in the back of the hips, going down the back of the leg starting where the buttocks meet the thigh, and perhaps also in the lower back. The pain often gets worse with standing and walking, and better when you’re lying down. It can be difficult to distinguish between SI joint pain and lumbar back pain, but your doctor can perform a number of tests that will help narrow down the cause. If you have SI pain, consider talking to your rheumatologist as this may change your diagnosis.
A variety of treatment techniques can ease SI joint problems. Wearing a sacroiliac belt can help provide support to this area, and strengthening the muscles in the pelvic area can help reduce pain. Steroid injection guided by x-rays may also be effective.
Prevention and treatment
As with RA in all your other joints, as well as the systemic effects of the disease, the best way to prevent damage to any of the joints discussed in this article is to use medication to suppress your RA. It can take some time to find a medication that works for you, but there are many treatment options available, and more in development.
Getting new information about the extent to which RA can affect your body may make you feel quite anxious. Keep in mind that information is power — the more you know, the more likely you are to catch any potential problems before they develop into something severe.
Did you know that RA can affect the joints mentioned in this article?
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Lene writes the award-winning blog The Seated View. She’s the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.