Objectives This paper aims to investigate adherence to, and outcome of, radiographic screening of patients with rheumatoid arthritis (RA) for cervical involvement, given the availability of state of the art disease-modifying anti-rheumatic drug (DMARD) and biological therapies. Methods Cervical screening results and clinical information were obtained from the charts of 395 consecutive patients with rheumatoid arthritis who attended an academic rheumatology outpatient clinic in a 3-month interval. This sample was combined with eight patients who underwent C1-C2 fusion at the Department of Orthopaedic Surgery. Results Reports on cervical spine x-ray films were not found in the charts of 67 patients (17 %), including 21 (8 %) of the 257 patients with a disease duration of =5 years. Nevertheless, 17 (7%) of these 257 patients had an increased atlantodental distance. An additional 4 RA patients of the Department of Orthopaedics were added for a total of 21 patients with cervical arthritis, 13 of whom had no cervical symptoms. All 21 patients with cervical arthritis had erosive peripheral arthritis with at least 10 years of disease duration, and were positive for rheumatoid factor. Almost half of these patients were not under adequate DMARD therapy when cervical instability was diagnosed, and none were on biological response modifiers. Conclusion Screening for cervical arthritis is still of importance, especially in patients with erosive seropositive disease. In view of the documented incidence, adherence to screening protocols was disappointing.