It is widely believed that brain stem dysfunction and cranlal nerve palsies in patients with rheumatoid arthritis (RA) are common and related to the vertical transiocation of the odontoid process. In our database of 235 patients with seropositive RA and craniocervical junction involvement, we have found a very low incidence of such problems. Long tract sings were common, but loss of propriception (joint position sensation) as the sole neurologic deficit was rare. Nystegmus was found to be associated with the tonsillar herniation of a Chiari 1 malformation and loss of joint position sensation with severe compression of the posterior aspect of the spinal cord at the craniocervical junction, particularly by sublaminar wiring, are discussed.