Introduction:
The aim of the study was to evaluate the risk factors for cervical instability in rheumatoid arthritis (RA).

Material and methods:
Computer searches were conducted in PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI) database, the Wan Fang database, the Chinese Scientific Journal Databases (VIP) database, and the Chinese Biomedical Literature database (CBM) from their establishment until November 2022.

Results:
A total of 8 articles were included in this study, including 1 cross-sectional study, 5 case-control studies, and 2 cohort study, including 3078 patients with RA. Meta analysis results showed that: male sex (OR = 1.70, 95% CI: 1.19–2.42), course of disease (OR = 1.72, 95% CI: 1.29–2.28), long-term glucocorticosteroid use (OR = 2.84, 95% CI: 1.97–2.40), Steinbrocker staging (OR = 2.30, 95% CI: 1.61–3.28), disability at baseline (OR = 24.57, 95% CI: 5.51–109.60), peripheral joint destruction (OR = 2.24, 95% CI: 1.56–3.21), Steinbrocker stage I-IV progression to disability (OR = 20.08, 95% CI: 4.18–96.53), and previous joint surgery (OR = 1.54, 95% CI: 1.06–2.26) are the main risk factors for cervical instability in RA.

Conclusions:
There are many risk factors for cervical instability in RA. In clinical practice, special attention should be paid to patients who are male, have a longer course of disease, have long-term glucocorticosteroid use, have previous joint surgery, have peripheral joint damage, and develop disability in Steinbrocker stage I-IV. Attention should be paid to the high-risk groups mentioned above, and effective measures such as early screening and full monitoring should be taken to prevent the occurrence of cervical instability in RA.