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Neurologic manifestations of rheumatoid arthritis

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


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".)

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Literature review current through: Nov 2017. | This topic last updated: Mar 17, 2016.
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