Cervical spine involvement in patients with rheumatoid arthritis ranges from 25% to 80%, with the peak incidence of the above cervical spine occurring between 30 and 50 years of age, with a male to female ratio of 1:3. Neck pain is most common, radiating to the occipital region, sometimes to the neck, eyes, scapula and back, and is aggravated by neck activity. Restriction of cervical spine movement is also common, and murmurs can be heard during cervical spine movement. Patients may have a short neck or oblique neck deformity at the time of presentation. When the spinal cord or medulla oblongata is involved, weakness of the extremities, hypesthesia, vertigo, and even dyspnea may occur, and sudden death may occur when the cerebral nerves and brain cadres are compressed. In addition, nerve root irritation symptoms such as numbness and pain in the upper limbs can occur. Because rheumatoid arthritis patients often have a combination of extremity lesions, joint pain and limited motion often make neurological examination difficult. X-ray manifestations of the disease: atlantoaxial subluxation, vertical subluxation, i.e., displacement of the dentate process toward the foramen magnum on lateral films, and subluxation of the lower cervical vertebrae; at a certain level of development, multiple subluxation deformities often coexist, i.e., mixed subluxation, where the patient has both upper and lower cervical subluxation, or anterior and posterior subluxation of the upper cervical vertebrae combined with rotational subluxation or combined with vertical subluxation. MRI can clearly show whether the cause of spinal cord compression is a bone structure or different degrees of soft tissue vascular opacification, and the degree of spinal cord compression. There are many treatments and medications for rheumatoid arthritis, but there are no specific medications available. The main objectives of treatment for cervical rheumatoid arthritis are: to prevent irreversible nerve damage, to prevent sudden death, and to relieve pain. Conservative treatment includes: 1. Proper nutrition and environment, mainly increasing high-protein and high-vitamin foods, and supplementing with vitamin D and calcium. Frequent sun exposure, protection against cold and moisture, etc.; 2. Proper rest and functional exercise, proper rest and reduced activity during the acute period, supplemented by cervical brace fixation and protection to reduce pain and prevent serious aggravation; functional exercise of the cervical spine should be started as far as possible during the remission period, combining active and passive, in the spirit of safety and gradual progress. Only a small percentage of patients with the disease require surgical treatment. For those with symptoms of nerve or spinal cord compression, for those for whom conservative treatment is ineffective, and for those with atlantoaxial subluxation, vertical subluxation or lower cervical subluxation, surgical treatment is recommended. Surgical options include posterior atlantoaxial fusion, posterior occipitocervical fusion, transoral dentatectomy, and lower cervical fusion.