Dysphagia due to vertical subluxation of the axis in rheumatoid arthritis

Two patients with rheumatoid arthritis developed swallowing difficulties. These were mild in one case but severe in the other. Associated pyramidal tract signs and striking upward translocation of the dens made it seem probable that dysphagia was attributable to medullary compression despite the absence of other bulbar features. A history of dysphagia may therefore have serious implications for patients with rheumatoid disease.