Rheumatoid arthritis (RA) is a chronic progressive systemic disorder affecting multiple synovial joints. Spine involvement, particularly at the craniocervical junction, usually occurs together with peripheral sites. The disease appears in the second to fourth decades and affects more women than men at a 3:1 ratio. The trigger for the disease is still unknown. It is believed to be an immune-mediated disease in which immune complexes are deposited in the synovial tissues. The inflamed synovial tissue, the pannus, contains giant cells, T and B lymphocytes, and plasma cells. As the pannus thickens and grows it invades adjacent structures, destroys the cartilage and bone, and leads to joint destruction, deformities, and instability. Eventually, fibrous or bony ankylosis may develop.

RA has a strong predilection to the cervical spine, especially but not exclusively to the C1-C2 region. The disease usually spares the thoracic, lumbar, and sacral regions. Up to 86% ofRA patients develop cervical spine pathology, which may progress and lead to neurological involvement.

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