UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Neurologic manifestations of rheumatoid arthritis

Authors
Monica L Piecyk, MD
Peter H Schur, MD
Section Editor
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Deputy Editor
Paul L Romain, MD

INTRODUCTION

Rheumatoid arthritis (RA) is associated with various nonarticular manifestations, including severe neurologic abnormalities. A variety of pathogenic mechanisms are responsible:

Rheumatoid synovitis and pannus may compress or invade adjacent structures (including the spinal cord and peripheral nerves), resulting in myelopathy, radiculopathy, and entrapment neuropathies.

Rheumatoid vasculitis may cause ischemia, infarction, or bleeding; these may ultimately result in transient ischemic attacks (TIA), stroke, quadriplegia, or paraparesis. With peripheral nervous system involvement due to vasculitis, there may be multiple nerve dysfunction (mononeuritis multiplex) or a more indolent polyneuropathy. (See "Clinical manifestations and diagnosis of rheumatoid vasculitis".)

The introduction of newer medications since the 1990s, along with more aggressive and effective strategies for the treatment of RA, appears to have reduced the frequency with which some of the neurologic manifestations of RA are observed.

Because both neurologic and muscular disorders may present with weakness, muscular diseases that occur in association with RA will also be reviewed here. Other nonarticular and non-neurologic problems associated with RA are also discussed elsewhere. (See "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis".)

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Mar 17 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Beck DO, Corbett JJ. Seizures due to central nervous system rheumatoid meningovasculitis. Neurology 1983; 33:1058.
  2. Kim RC, Collins GH. The neuropathology of rheumatoid disease. Hum Pathol 1981; 12:5.
  3. Mandybur TI. Cerebral amyloid angiopathy: possible relationship to rheumatoid vasculitis. Neurology 1979; 29:1336.
  4. Ramos M, Mandybur TI. Cerebral vasculitis in rheumatoid arthritis. Arch Neurol 1975; 32:271.
  5. Singleton JD, West SG, Reddy VV, Rak KM. Cerebral vasculitis complicating rheumatoid arthritis. South Med J 1995; 88:470.
  6. STEINER JW, GELBLOOM AJ. Intracranial manifestations in two cases of systemic rheumatoid disease. Arthritis Rheum 1959; 2:537.
  7. Watson P. Intracranial hemorrhage with vasculitis in rheumatoid arthritis. Arch Neurol 1979; 36:58.
  8. Watson P, Fekete J, Deck J. Central nervous system vasculitis in rheumatoid arthritis. Can J Neurol Sci 1977; 4:269.
  9. Scott DG, Bacon PA, Tribe CR. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine (Baltimore) 1981; 60:288.
  10. Sigal LH. The neurologic presentation of vasculitic and rheumatologic syndromes. A review. Medicine (Baltimore) 1987; 66:157.
  11. Bekkelund SI, Pierre-Jerome C, Husby G, Mellgren SI. Quantitative cerebral MR in rheumatoid arthritis. AJNR Am J Neuroradiol 1995; 16:767.
  12. Bathon JM, Moreland LW, DiBartolomeo AG. Inflammatory central nervous system involvement in rheumatoid arthritis. Semin Arthritis Rheum 1989; 18:258.
  13. Takahashi M, Yamamoto J, Idei M, et al. Multiple intracranial nodules associated with rheumatoid arthritis: case report. Neurol Med Chir (Tokyo) 2014; 54:317.
  14. Friedman H. Intraspinal rheumatoid nodule causing nerve root compression. Case report. J Neurosurg 1970; 32:689.
  15. Hauge T, Magnaes B, Løken AC, de Graaf AS. Treatment of rheumatoid pachymeningitis involving the entire thoracic region. Scand J Rheumatol 1978; 7:209.
  16. Contin JU, Oka M. Unusual cardiac, pulmonary and meningeal involvement in rheumatoid arthritis. Report of a case. Dis Chest 1966; 49:552.
  17. Jackson CG, Chess RL, Ward JR. A case of rheumatoid nodule formation within the central nervous system and review of the literature. J Rheumatol 1984; 11:237.
  18. Sunter JP. Rheumatoid disease with involvement of the leptomeninges presenting as symptomatic epilepsy. Beitr Pathol 1977; 161:194.
  19. Kim RC, Collins GH, Parisi JE. Rheumatoid nodule formation within the choroid plexus. Report of a second case. Arch Pathol Lab Med 1982; 106:83.
  20. Chowdhry V, Kumar N, Lachance DH, et al. An unusual presentation of rheumatoid meningitis. J Neuroimaging 2005; 15:286.
  21. Starosta MA, Brandwein SR. Clinical manifestations and treatment of rheumatoid pachymeningitis. Neurology 2007; 68:1079.
  22. Bourgeois P, Rivest J, Bocti C. Rheumatoid meningitis presenting with stroke-like episodes. Neurology 2014; 82:1564.
  23. Magaki S, Chang E, Hammond RR, et al. Two cases of rheumatoid meningitis. Neuropathology 2016; 36:93.
  24. Gupta VP, Ehrlich GE. Organic brain syndrome in rheumatoid arthritis following corticosteroid withdrawal. Arthritis Rheum 1976; 19:1333.
  25. Nakano KK. Neurologic complications of rheumatoid arthritis. Orthop Clin North Am 1975; 6:861.
  26. Fleischmann RM. Progressive multifocal leukoencephalopathy following rituximab treatment in a patient with rheumatoid arthritis. Arthritis Rheum 2009; 60:3225.
  27. Ray M, Curtis JR, Baddley JW. A case report of progressive multifocal leucoencephalopathy (PML) associated with adalimumab. Ann Rheum Dis 2014; 73:1429.
  28. González-Suárez I, Aguilar-Amat MJ, Trigueros M, et al. Leukoencephalopathy due to oral methotrexate. Cerebellum 2014; 13:178.
  29. Furst DE, Keystone EC, Braun J, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2011. Ann Rheum Dis 2012; 71 Suppl 2:i2.
  30. Clifford DB, Ances B, Costello C, et al. Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis. Arch Neurol 2011; 68:1156.
  31. Molloy ES, Calabrese LH. Progressive multifocal leukoencephalopathy: a national estimate of frequency in systemic lupus erythematosus and other rheumatic diseases. Arthritis Rheum 2009; 60:3761.
  32. Zakzook SI, Yunus MB, Mulconrey DS. Hyperviscosity syndrome in rheumatoid arthritis with Felty's syndrome: case report and review of the literature. Clin Rheumatol 2002; 21:82.
  33. Aviña-Zubieta JA, Choi HK, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008; 59:1690.
  34. Bacani AK, Gabriel SE, Crowson CS, et al. Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Arthritis Rheum 2012; 64:53.
  35. Nadareishvili Z, Michaud K, Hallenbeck JM, Wolfe F. Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: a nested, case-control study. Arthritis Rheum 2008; 59:1090.
  36. Solomon DH, Goodson NJ, Katz JN, et al. Patterns of cardiovascular risk in rheumatoid arthritis. Ann Rheum Dis 2006; 65:1608.
  37. Lindhardsen J, Ahlehoff O, Gislason GH, et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ 2012; 344:e1257.
  38. Nakano KK. The entrapment neuropathies of rheumatoid arthritis. Orthop Clin North Am 1975; 6:837.
  39. Herbison GJ, Teng C, Martin JH, Ditunno JF Jr. Carpal tunnel syndrome in rheumatoid arthritis. Am J Phys Med 1973; 52:68.
  40. Brick JE, Brick JF. Neurologic manifestations of rheumatologic disease. Neurol Clin 1989; 7:629.
  41. PALLIS CA, SCOTT JT. PERIPHERAL NEUROPATHY IN RHEUMATOID ARTHRITIS. Br Med J 1965; 1:1141.
  42. Barnes CG, Currey HL. Carpal tunnel syndrome in rheumatoid arthritis. A clinical and electrodiagnostic survey. Ann Rheum Dis 1967; 26:226.
  43. Chamberlain MA, Corbett M. Carpal tunnel syndrome in early rheumatoid arthritis. Ann Rheum Dis 1970; 29:149.
  44. Fleming A, Dodman S, Crown JM, Corbett M. Extra-articular features in early rheumatoid disease. Br Med J 1976; 1:1241.
  45. Chang DJ, Paget SA. Neurologic complications of rheumatoid arthritis. Rheum Dis Clin North Am 1993; 19:955.
  46. Hurd ER. Extraarticular manifestations of rheumatoid arthritis. Semin Arthritis Rheum 1979; 8:151.
  47. Baylan SP, Paik SW, Barnert AL, et al. Prevalence of the tarsal tunnel syndrome in rheumatoid arthritis. Rheumatol Rehabil 1981; 20:148.
  48. Grabois M, Puentes J, Lidsky M. Tarsal tunnel syndrome in rheumatoid arthritis. Arch Phys Med Rehabil 1981; 62:401.
  49. McGuigan L, Burke D, Fleming A. Tarsal tunnel syndrome and peripheral neuropathy in rheumatoid disease. Ann Rheum Dis 1983; 42:128.
  50. FERGUSON RH, SLOCUMB CH. Peripheral neuropathy in rheumatoid arthritis. Bull Rheum Dis 1961; 11:251.
  51. White SH, Goodfellow JW, Mowat A. Posterior interosseous nerve palsy in rheumatoid arthritis. J Bone Joint Surg Br 1988; 70:468.
  52. Bekkelund SI, Torbergsen T, Husby G, Mellgren SI. Myopathy and neuropathy in rheumatoid arthritis. A quantitative controlled electromyographic study. J Rheumatol 1999; 26:2348.
  53. Chamberlain MA, Bruckner FE. Rheumatoid neuropathy. Clinical and electrophysiological features. Ann Rheum Dis 1970; 29:609.
  54. Haslock DI, Wright V, Harriman DG. Neuromuscular disorders in rheumatoid arthritis. A motor-point muscle biopsy study. Q J Med 1970; 39:335.
  55. Weller RO, Bruckner FE, Chamberlain MA. Rheumatoid neuropathy: a histological and electrophysiological study. J Neurol Neurosurg Psychiatry 1970; 33:592.
  56. Conn DL, McDuffie FC, Dyck PJ. Immunopathologic study of sural nerves in rheumatoid arthritis. Arthritis Rheum 1972; 15:135.
  57. Goldman JA, Casey HL, McIlwain H, et al. Limited plasmapheresis in rheumatoid arthritis with vasculitis. Arthritis Rheum 1979; 22:1146.
  58. Lanzillo B, Pappone N, Crisci C, et al. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum 1998; 41:1196.
  59. Edmonds ME, Jones TC, Saunders WA, Sturrock RD. Autonomic neuropathy in rheumatoid arthritis. Br Med J 1979; 2:173.
  60. Reza MJ, Verity MA. Neuromuscular manifestations of rheumatoid arthritis: A clinical and histomorphological analysis. Clin Rheum Dis 1977; 3:565.
  61. Halla JT, Koopman WJ, Fallahi S, et al. Rheumatoid myositis. Clinical and histologic features and possible pathogenesis. Arthritis Rheum 1984; 27:737.
  62. Haslock DI, Harriman DF, Wright V. Neuromuscular disorders associated with rheumatoid arthritis. Ann Rheum Dis 1970; 29:197.
  63. Askari A, Vignos PJ Jr, Moskowitz RW. Steroid myopathy in connective tissue disease. Am J Med 1976; 61:485.
  64. Wegelius O, Pasternack A, Kuhlbäck B. Muscular involvement in rheumatoid arthritis. Acta Rheumatol Scand 1969; 15:257.
  65. Rheumatology, 2nd, Klippel JH, Dieppe PA (Eds), Mosby, Philadelphia 1998.
  66. Kaltsonoudis E, Zikou AK, Voulgari PV, et al. Neurological adverse events in patients receiving anti-TNF therapy: a prospective imaging and electrophysiological study. Arthritis Res Ther 2014; 16:R125.