A multivariate analysis of the clinical and radiographic findings of 70 patients with rheumatoid arthritis (RA) was studied. Linear multiple regression analysis was performed on 23 clinical variables. The factors that contributed highly to the progression of vertical atlanto-axial subluxation (VS) were gender, presence of arthritis mutilans, blood hemoglobin level, carpal height ratio (CHR) and the number of joints treated by arthroplasty. This result suggests that the natural progression of VS may well relate to the indicators of the severity of destructive conditions. In contrast, anterior atlanto-axial subluxation (AAS) showed no statistical correlation with any factors. Therefore, the severity of AAS does not appear to be related to the factors that were closely related to VS. A follow-up study of the radiological changes in the cervical spine and hand was performed. There was a high correlation between the severity of VS and the reduction of CHR. As destructive changes in the hands were common and irreversible findings in RA, CHR was the most objective of the factors correlated with VS. Therefore, the measurement of CHR is useful in evaluating the progression of VS.