Rheumatoid arthritis in the cervical spine: what you need to know.

Patients diagnosed with rheumatoid arthritis (RA) are among the most difficult for orthopedic surgeons to treat. Cervical spine involvement is the manifestation of RA that is most likely to cause rapidly progressive disability or sudden death. Management of the rheumatoid cervical spine remains a challenge for experienced spine surgeons and can be especially daunting for general orthopedic surgeons and nonspine specialists alike. This complicated process is simplified by using a straightforward approach based on 5 fundamental questions: 1. What is the scope of the problem? 2. What should I look for in my patients? 3. What can I do for my patients? 4. When should I ask for help? 5. What can others do for my patients? In this review, we answer these questions and provide the information needed to evaluate the cervical spine in patients with RA.