Neck pain and rheumatic disease 3.9/5 (10)

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Neck pain and rheumatic disease. Illustration: FotoFyl / E. Tsavari. CC BY 2.0

Definition

Pain in the neck is common and most often caused by harmless, though troublesome muscles. The symptoms can come on acutely or during periods of stress or a lot of work, for example in front of a computer screen. However, there are other and sometimes serious diseases that can also cause neck pain. Below is a selection listed alphabetically, then a list of "Red flags" / danger signals.

Causes of neck pain (alphabetical)

  • Myelitis (inflammation of the spinal cord) See also SLE above
  • Polymyalgia rheumatica (PMR)
    • Never before 50's age
    • Quick start (within hours)
    • High CRP and lowering response (SR)
    • At the same time in both shoulders, pelvic or thighs
  • Prolapse of intervertebral discs ("neck prolapse"): See separate section below
  • Systemic lupus erythematosus (SLE) with spinal cord manifestation / myelitis (rare)
  • Takayasu arteritis
    • High CRP and lowering reaction (SR)
    • Pain on the side of the throat (over arteries, carotidynia)
    • Young women
  • Whiplash  Various forms of neck injury after sudden overexertion (extension). Most often associated with a car accident with a rear-end collision. The mechanism behind chronic pain is often unclear

6 Red Flags (Danger Signals):

  1. Troublesome symptoms for more than 6 weeks
  2. No improvement or gradual deterioration over time
  3. Pain radiate to arm or leg
  4. Pain by knocking against the vertebra of the neck
  5. Numbness or loss of muscle strength
  6. Other new symptoms (unexplained new night sweats, fever, weight loss, headache, nausea)

Examinations for neck pain

Disease history: The symptoms from the onset of the disease are assessed. Neck prolapse and "kink" begin abruptly or within a few hours. Infections are noticed by rapid deterioration. In prolapse, the pain may radiate to the shoulder, upper arm, forearm and / or hand and fingers, often with numbness. Rheumatic inflammation often occurs more gradually and may be most pronounced in the morning with improvement in activity. Symptoms of other illness (which may be related) are noted, corresponding to pain elsewhere in the body and whether the general condition (fatigue, new night sweats, fever, weight loss) is affected.

Clinical examination (GP, neurologist, rheumatologist) assesses whether nerves are affected, one looks for muscle pain, signs of rheumatic disease and infection.

Laboratory tests may include CRP, lowering reaction / SR, blood cell count, liver and kidney function tests and more.

Imaging with X-rays rarely reveal causes, CT images can show skeletal changes and calcifications, while MRI scans most often provide information about intervertebral discs (neck prolapse), signs of infection, rheumatic inflammation, tumors or disease of the spinal cord.

Headache and rheumatic disease are described here (in Danish) (Vaskulitt.no)

Debt pain and rheumatic disease have their own side here (in Danish)


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