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OBJECTIVE: At present, there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis, but there are problems such as small sample size and many confounding factors, and the research results of various studies on the same related factors are also different. This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS: Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023. The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information, baseline patient characteristics, laboratory-related tests, medication use, and other relevant risk factors. Meta-analysis was done using Stata 14.0 software. RESULTS: (1) Sixteen relevant studies, all of moderate or above quality, were included, including seven studies with case-control studies and nine with cross-sectional studies. The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%. (2) Meta-analysis showed: Related risk factors included female (OR=0.60, 95%CI: 0.44-0.82, P=0.002); age at disease onset (SMD=-0.52, 95%CI: -0.86 to -0.18, P=0.003); duration of disease (SMD=0.58, 95%CI: 0.14-1.02, P=0.01); body mass index (OR=0.74, 95%CI: 0.63-0.88, P=0.001); rheumatoid factors positive univariate analysis subgroup (OR=1.33, 95%CI:1.02 to 1.72, P=0.04), C-reactive protein (SMD=0.26, 95%CI: 0.16-0.35, P=0.00), erythrocyte sedimentation rate (SMD=0.15, 95%CI: 0.002-0.29, P=0.047), anti-cyclic-citrullinated peptide antibodies (OR=1.73, 95%CI: 1.19-2.51, P=0.004), 28-joint Disease Activity Score (SMD=0.20, 95%CI: 0.04-0.37, P=0.02), destruction of peripheral joints (OR=2.48, 95%CI: 1.60-3.85, P=0.00), and corticosteroids (OR=1.91, 95%CI: 1.54-2.37, P=0.00) were strongly associated with the development of rheumatoid arthritis-cervical spine instability. Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION: Based on clinical evidence from 16 observational studies, the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%. However, the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies. Gender (female) and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis. The results of this study still provide some guidance for early clinical recognition, diagnosis, and prevention of rheumatoid arthritis-cervical spine instability. [ABSTRACT FROM AUTHOR]