Rheumatoid patients with injuries are treated by orthopaedic rheumatologists as well as trauma surgeons. Surgeons must take account of numerous factors that influence the treatment of this special patient population, e. g. immunosuppressive drugs, severe osteoporosis, atrophy of the skin, subcutaneous fat and muscles joint instability and arteriosclerosis. This requires knowledge in immunology, pharmacology and the entire spectrum of internal medicine, as well as special care in the treatment of vulnerable tissues. In polytrauma patients with inflammatory diseases, rheuma toid serositis may be misinterpreted with a lethal outcome. Because of the high lethality, vertebral fractures related to ankylosing spondylitis have to be treated very carefully. Instability of the cervical spine, especially the atlantooccipital and atlantoaxial joints, is common in long-standing rheumatoid arthritis, and manipulation of the cervical spine may lead to cervical cord injury with respiratory arrest.