Rheumatoid Arthritis

To the Editor: The review article by Gravallese and Firestein (Feb. 9 issue)1 discusses the complications of rheumatoid arthritis and coexisting conditions. However, cervical spine involvement in rheumatoid arthritis is not mentioned. In fact, rheumatoid arthritis has a characteristic predilection for the cervical spine, and the prevalence of cervical spine involvement is between 17% and 86% among patients with rheumatoid arthritis.2 The atlantoaxial region is the most common site of involvement.3 Rheumatoid arthritis can cause instability of the cervical spine through progressive destruction of the small synovial joints with associated vascular, metabolic, and osseous damage.4 This instability includes atlantoaxial instability. © 2023 Massachusetts Medical Society.