A 59-year-old man presented with neck pain and limb numbness. He also had bilateral symmetrical joint deformities of his hands and wrists. Cervical spine radiographs showed C 1/2 instability and features of rheumatoid arthritis. Magnetic resonance imaging demonstrated erosion ofthe odontoid peg by pannus. C 1/2 surgical fusion was performed. The role of imaging in cervical spine involvement by rheumatoid arthritis is reviewed.