Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by an inflammatory, symmetric polyarthritis. The mechanisms by which RA patients are predisposed to stroke are varied. The most common of these causes is atherosclerotic disease, which seems to be accelerated by the underlying RA. The role of systemic inflammation in mediating atherosclerotic disease is becoming clear and may be the underlying link between RA and vascular events. Systemic vasculitis in RA involves the vasa nervorum of the peripheral nervous system. Meningeal and brain biopsy remains the gold standard in confirming a diagnosis of vasculitis in RA patients. Although there is a theoretical risk of mechanical injury to the vertebral artery due to cervical arthritis and atlantoaxial subluxation in RA, this most often results in cervical myelopathy. Stroke due to vertebral dissection has been reported in RA, but the vertebral artery occlusion was sometimes associated with only minimal atlantoaxial subluxation.