Which symptom is associated with atlantoaxial subluxation in rheumatoid arthritis?

• A. Loss of consciousness
• B. Dysphasia
• C. Sensation of head falling forward with neck flexion
• D. Seizures

Answer: (C)

Atlantoaxial subluxation in rheumatoid arthritis happens when inflammation weakens the ligaments and support around the C1–C2 joints, allowing the atlas to move anteriorly relative to the axis, especially with neck flexion. As the head is bent forward, this instability can cause the skull to shift and compress the upper spinal cord or brainstem. The sensation of the head falling forward with neck flexion captures this dynamic instability and the mechanical sense that the head cannot be held upright when the neck is flexed. Other options describe more general or different neurological events and aren’t the classic early sign of this cervical instability in RA.