Comparing radiographs of the cervical spine from young adults with polyarticular juvenile idiopathic arthritis (pJIA) with or without cervical symptoms (n = 57) with those from adults (<55 years of age) with rheumatoid arthritis (RA) (n = 58) showed that 65% of pJIA and 67% of RA patients had cervical lesions; however, 51% of patients with pJIA with radiographic abnormalities had no clinical symptoms. Radiographic cervical lesions were directly associated with more severe disease, so the authors recommend regular cervical spine radiographic assessment in patients with pJIA.