Over my life I’ve had to make several trips to the emergency room. Most of these were from acute situations, occurred during childhood, and involved accidents from wild, boyhood behaviors. One time I was jumping a ramp on my bike and my jaw landed on the sidewalk resulting in six stitches and a permanent scar. But yesterday I found myself at the ER for a chronic situation that got out of hand.
I’ve lived with neck pain over the past couple of years and my rheumatologist had an x-ray done in 2012. Nothing significant was seen. Pain continued to gain in intensity and it began to radiate down my neck into the shoulders. I assumed that it was muscle tension and sometimes took muscle relaxants at night. About a month ago I began to notice tingling in my left fingers. I was getting physical therapy for my right elbow and the therapist said that it was likely caused by inflammation in my elbow and wrist (cubital and carpal tunnel syndrome – common in RA). The pain continued to grow in intensity and the past week it got to the point where it felt like holding up the 12 pound bowling ball which is my head was just not possible. On Thursday I left work at 3:00 in the afternoon with such intense pain that I could barely drive. I made it to my home city and actually pulled into the hospital parking lot wondering if I should walk into the emergency room. I called my rheumatologist’s office and told them what was happening. They made an appointment for the next morning and said that I should go to the ER if I felt it was needed. I eventually drove home and tried to nurse my neck. Even after taking muscle relaxants, sleeping was not possible and I woke up at 3 in the morning. I barely made it to the appointment with my rheumatologist in the morning. After a few moments talking and examining me, she looked directly me in the eye and said that I needed to go to the ER because it was clear that I needed immediate pain management and a diagnosis of what was going on. She offered to call an ambulance but I told her I would drive myself – call me crazy or stubborn.
I got to the ER and walked in. They immediately took me to an exam room and began to get vitals and ask me what was going on. The doctor prescribed major pain meds via IV and they had to double to dose after the first one didn’t help much. He ruled out infection and accident and suspected neck problems from rheumatoid arthritis. He ordered an MRI on my neck. The intense pain made it tough to lie still in the MRI machine. The MRI revealed spondylosis (degenerative arthritis), two herniated discs pushing into the spinal cord, and bone spurs pushing into radiating nerves (see MRI picture). The cause of the pain and tingling was finally revealed. The ER doctor actually called my rheumatologist and had a conversation with her about the situation. He sent me home with pain meds and steroids. I have an appointment Monday morning with a spinal surgeon to determine next steps.
Most people think of RA only impacting small joints like the fingers. In fact, the ER doctor mentioned that when first talking to me but I told him that most of my large joints including ankles, knees, hips, elbows, and shoulders show RA induced damage. Now it appears my neck has also been impacted. According to a 2006 article in the journal Rheumatology, “The polyarthropathy of rheumatoid arthritis affects the joints of the spine, and particularly the upper cervical spine.” The lesson from this situation is don’t ignore neck pain if you have RA!