The craniovertebral junction showed significant involvement in the individuals with early rheumatoid arthritis (ERA), as per recent research conducted at the VRAI - Marche Polytechnic University, Italy. Rheumatoid arthritis shows a considerable association with spine issues. The main spine indications of RA involve; subaxial subluxation, basilar invagination, and atlantoaxial instability.

The analysis involved a total of 50 consecutive ERA patients with mean age of 58.2 years. All patients went through X-ray and MRI of feet, hands, cervical spine and wrists. The MRI characteristics were associated with biochemical, radiological and clinical variables.

A total of 24% of patients were found to have involvement of craniovertebral junction. A significant higher Simple Erosion Narrowing Score (SENS), higher anti-citrullinated protein antibodies (ACPA) titer, a worse Health Assessment Questionnaire Disability Index (HAQ-DI) and worse Disease Activity Score 44 joints (DAS44) were noticed among patients with atlantoaxial synovitis. Atlantoaxial synovitis showed a significant association with DAS44, the presence of erosive disease, and ACPA.