For a retrospective cohort study, the researchers sought to investigate the factors that contribute to the severe exacerbation of preexisting cervical lesions in patients with rheumatoid arthritis (RA) who were receiving biologic therapies. A total of 87 individuals with prior cervical lesions were retrospectively examined among 166 patients who had cervical X-ray pictures taken at baseline and the final visit (with a gap of more than 1 year). Atlantoaxial subluxation (AAS) was defined as an Atlanta dental interval of more than or equal to 10 mm; vertebral subluxation (VS) was defined as a Ranawat value of less than 10 mm, and subaxial subluxation (SAS) was defined as an anterior vertebral slip of more than or equal to 4 mm or a multilevel slip of more than or equal to 2 mm. Based on the radiography data, patients were separated into 2 groups: severe aggravation and non-severe aggravation. There were 14 patients in the severe group (16.1%). In terms of demographic data, there was no substantial difference between the two groups. Preexisting SAS lesions (odds ratio: 7.59, 95% CI: 1.16–49.6) and no history of biologic treatment (odds ratio: 0.10; 95% CI: 0.17–0.58) were linked to aggravation in multivariate logistic regression analysis. Pre Existing SAS lesions were linked to worsening. Biologicals, on the other hand, might have been useful in preventing aggravation.