Inflammatory central nervous system involvement in rheumatoid arthritis

Joan M. Bathon, Larry W. Moreland, Anthony G. DiBartolomeo

Research output: Contribution to journalArticle

Abstract

We describe a patient with seropositive rheumatoid arthritis who developed pachymeningitis resulting in optic atrophy. Clinical, histopathologic, and radiologic findings in 18 additional cases of inflammatory CNS disease associated with rheumatoid arthritis are reviewed. The three characteristic neuropathologic findings were rheumatoid nodules, pachymeningitis or leptomeningitis, and vasculitis. In most cases, more than one of these histopathologic processes were found. The typical host was middle-aged with long-standing severe nodular disease. However, contrary to previous reports, CNS disease occurred in a significant number of patients without active synovitis and extracranial vasculitis and nodules. Although no correlation between specific neurologic symptoms and neuropathology was noted, patients with CNS nodules tended to be asymptomatic more often than patients with vasculitis or meningitis. CSF analysis and computed axial tomography were helpful diagnostic tools, but diagnosis was ultimately made only by directed biopsy or at autopsy. Treatment with surgical decompression and/or corticosteroids has proved beneficial in several cases. Inflammatory CNS involvement in rheumatoid arthritis should be considered in any patient with neurologic symptoms in whom infectious and malignant processes are ruled out. An aggressive, invasive approach for diagnostic biopsies seems warranted.

Original languageEnglish (US)
Pages (from-to)258-266
Number of pages9
JournalSeminars in Arthritis and Rheumatism
Volume18
Issue number4
DOIs
StatePublished - 1989

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Rheumatoid Arthritis
Central Nervous System
Vasculitis
Meningitis
Central Nervous System Diseases
Neurologic Manifestations
Rheumatoid Nodule
Biopsy
Surgical Decompression
Optic Atrophy
Synovitis
Autopsy
Adrenal Cortex Hormones
Tomography
Therapeutics

Keywords

  • central nervous system
  • meningitis
  • nodules
  • Rheumatoid arthritis
  • vasculitis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

Inflammatory central nervous system involvement in rheumatoid arthritis. / Bathon, Joan M.; Moreland, Larry W.; DiBartolomeo, Anthony G.

In: Seminars in Arthritis and Rheumatism, Vol. 18, No. 4, 1989, p. 258-266.

Research output: Contribution to journalArticle

Bathon, Joan M. ; Moreland, Larry W. ; DiBartolomeo, Anthony G. / Inflammatory central nervous system involvement in rheumatoid arthritis. In: Seminars in Arthritis and Rheumatism. 1989 ; Vol. 18, No. 4. pp. 258-266.
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