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Neurologic manifestations of rheumatoid arthritis

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".)

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".)

CENTRAL NERVOUS SYSTEM

Disorders of the central nervous system (CNS) due to RA include cervical myelopathy, vasculitis, rheumatoid nodules located within the CNS, meningitis, organic brain syndrome, and (rarely) progressive multifocal leukoencephalopathy. Stroke also occurs with increased frequency, but the basis for this association is not well understood.

Cervical myelopathy — Cervical myelopathy (cervical myeloradiculopathy) resulting from atlantoaxial subluxation, atlantoaxial impaction, and/or subaxial subluxation is discussed separately. (See "Cervical subluxation in rheumatoid arthritis".)
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