Rheumatoid arthritis (RA) commonly affects peripheral joints but can also affect the neck vertebrae, which can lead to back pain. You can relieve discomfort with medical treatments, exercise, and home remedies.

Rheumatoid arthritis (RA) symptoms commonly occur in the joints of your hands, wrists, feet, elbows, ankles, and hips. Your immune system attacks the synovium — the membrane lining of your joints — which leads to inflammation and pain.

In 44% to 86% of people with RA, the condition may cause lesions in the cervical spine in your neck. This usually affects the C1 and C2 vertebrae, a synovial lined joint. If severe, this can then lead to spinal cord compression.

For people with advanced RA, it can cause compression of the spinal cord and nerve roots. When this happens, you can experience moderate to severe pain.

Keep reading to learn about short-term treatments for back pain and long-term back pain management steps.

The C1 and C2 vertebrae in your neck connect to your skull and the rest of your spine.

When RA affects this region, it can cause you to have difficulty with stability and to experience stiffness and pain throughout your back.

RA pain can be different for each person. It can be dull or sharp, or it may just feel like tightness.

Some people with RA may have pain radiating up the back of their head. This could feel like a dull pain. Alternatively, it may feel like an electric shock, which is a phenomenon called Lhermitte’s sign that can occur with different conditions, including RA.

Experts don’t currently know why RA affects some joints. But since the C1 and C2 vertebrae are a synovial lined joint and RA attacks the synovium, RA can impact this area.

Pain in the mid to lower back usually isn’t from RA, although it might be.

Before looking at treatments for your back pain, you’ll need to know if your back pain is caused by a condition or injury.

Acute back pain is usually a result of straining your back. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says to avoid bed rest and instead to limit activity that causes pain.

Over-the-counter pain relievers and hot or cold packs might also help. It will usually get better over time.

Chronic back pain is different. It’s a long-term problem caused by conditions such as RA. It can be treated in a number of ways, and exercise can be beneficial.

Hot and cold packs can’t treat the underlying causes of back pain, but they can help lower the pain and stiffness you feel during a flare-up.

Use a heat pack to help improve blood flow and reduce muscle spasms. It can also help make your pain more manageable.

Use a cold pack to help lower RA inflammation. It should mainly be used for flare-ups or acute pain.

Cold packs may feel uncomfortable at first, but they can lower swelling and help with pain. Cold packs should only be applied for 20 to 30 minutes at a time in order to avoid skin damage, and shouldn’t directly touch your skin.

Medication can be an effective way of managing chronic back pain. The type of medication you’ll need depends on how severe your pain is and how often you experience it.

A variety of medications can relieve pain and even slow the progression of RA.

Pain relievers

Managing your pain is important when learning to live with a chronic back problem. Analgesics, or pain relievers, are one way of easing back pain.

Over-the-counter drugs such as aspirin may be enough to manage mild pain, but a doctor or healthcare professional may prescribe stronger medications for people with more severe RA. This might include:

  • a stronger nonsteroidal anti-inflammatory drug (NSAID)
  • an anticonvulsant such as gabapentin (Neurontin)

Nonsteroidal anti-inflammatory drugs

NSAIDs can soothe pain and inflammation. Anti-inflammatory treatments are helpful because they lower swelling. This can ease pressure on your back and help make movement easier.

Ibuprofen (Advil, Motrin IB) and naproxen (Aleve) are two NSAIDs that are available over the counter. There are also stronger NSAIDs that your doctor may prescribe, such as celecoxib (Celebrex).

NSAIDs may cause side effects, such as stomach bleeding. You may want to ask your doctor if you should take it with food.

A doctor will be able to help you decide if NSAIDs are right for you based on your medical history.

Disease-modifying antirheumatic drugs

Disease-modifying antirheumatic drugs (DMARDs) are prescribed to help soothe pain and slow the progression of RA. They can help stop future pain flare-ups. A commonly prescribed DMARD is methotrexate.

DMARDs work by interfering with the cellular process causing antibodies to attack your joint tissue. This prevents further damage to your bones and cartilage.

DMARDs can cause side effects, such as:

  • nausea
  • skin rashes
  • fatigue
  • liver damage
  • abnormal white blood cell counts, leading to infection

A doctor can help you manage these side effects if they occur.

Spinal injections

A spinal injection can be a quick way to relieve chronic back pain. It usually means injecting a corticosteroid or anesthetic into the nerve region that’s being affected by RA inflammation.

The effects of a spinal injection can last for weeks or even months. However, corticosteroids may lead to other health problems, such as osteoporosis. For this reason, healthcare professionals often suggest you wait several months between injections.

Surgery is usually the last resort for back pain treatment. While it can be effective in helping to ease chronic back pain, it’s not always successful at lowering pain.

If surgery is recommended, a doctor may consider a “fusion” procedure. This involves cutting out the diseased joint and bonding the vertebrae together, decreasing mobility. For some people, this will ease the pain in that area.

Another approach is realigning and stabilizing your spine to ease pressure on your spine’s nerves. This can lessen pain and even improve mobility.

A range of therapies can help support your back pain treatment. For instance, physiotherapy could improve your flexibility and muscle strength.

Research from 2022 suggests that occupational therapy can also be useful. This kind of therapy teaches you joint protection strategies. An example might be how to pick up and carry objects without causing back pain.

Chiropractic therapy isn’t usually recommended for people with RA who are having back pain. It could be used to treat the C1 and C2 vertebrae, but there are risks.

One of the most serious risks of chiropractic therapy is that it can trigger spinal cord compression, leading to paralysis. Rarely, a chiropractic adjustment can also cause a vertebral artery dissection. This can lead to a stroke.

Appropriate exercise can help take pressure off of your back and keep joints supple if you’re experiencing chronic back pain due to RA. Exercise also helps keep up your overall health.

NIAMS recommends exercises that increase balance and strength, such as tai chi or yoga. Water-based exercises such as swimming or water aerobics can also be helpful.

Always consult a doctor before starting any fitness program for your back pain.

What are some RA back pain exercises?

A few exercises that may help lower RA-related back pain include the pelvic tilt, the back stabilizer, and the deep lunge.

What is the relationship between RA and sciatica?

Though these are different conditions, it may be hard to tell whether your pain is caused by RA or sciatica. Sciatica pain happens because of pressure against the sciatic nerve.

If you’re unsure if your back pain is related to RA, you should consult a doctor for a correct diagnosis and treatment.

What are other causes of back pain?

Acute back pain is usually caused by an injury. Causes of chronic back pain can include other types of arthritis, ankylosing spondylitis, osteoporosis, kidney stones, spinal infections, endometriosis, or tumors in your back.

If you have rheumatoid arthritis and think you have chronic back pain, talk with a doctor. They can help you find the right treatment for your particular condition.

Whether that means short-term solutions such as ice packs and medications or long-term pain management strategies such as occupational therapy or an appropriate exercise plan, you can find relief from your back pain.