Rheumatoid arthritis can affect any of the synovial joints in the vertebral column. However, the cervical spine, which is the most commonly involved, is the region where segmental instability can lead to neurological sequelae. Severe pain may also be a feature demanding relief. The natural history of the disease as it affects the cervical spine must be a yardstick of management, because quite severe subluxation can occur without neurological embarrassment, whilst a small segmental shift may have profound neurological implications. It is with this knowledge that surgical fusion is offered to a few selected patients. Our own cases are derived from the Medical Research Council Rheumatism Unit at Taplow and the paper will also include experience of Juvenile Chronic Arthritis and ankylosing Spondylitis.