Prevalence and patterns of peripheral neuropathy in patients of rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disorder characterized by involvement of multiple small and large joints with multisystem extra-articular manifestations. Peripheral neuropathy is known extra-articular manifestation of RA with the incidence of around 39.19% as per previous studies. Early diagnosis and treatment of peripheral neuropathy has been shown to improve both physical and functional disabilities of patients with RA. Objectives: The primary objective was to study prevalence and patterns of peripheral neuropathy in patients with RA. The secondary objective was to study demographic, clinical parameters, disease severity, and extra- articular manifestations in patients with RA with and without peripheral neuropathy. Materials and Methods: Consecutive patients of RA were recruited. Detailed clinical examination and electrophysiological tests were done to diagnose peripheral neuropathy. The demographic and clinical parameters were noted and tabulated. Student's t -test was used to analyze continuous variable, whereas Chi-square test was used for analysis of categorical variables. Results: Of 89 patients with RA, 75.28% ( n = 67) patients had peripheral neuropathy electrophysiologically, whereas 20.89% (14 patients of 67) had superficial touch sensory loss on examination. Subclinical neuropathy was present in 50.74% ( n = 34) of patients. Statistically significant association between the presence of neuropathy and age of the patients, disease duration, use of disease-modifying antirheumatoid drugs, disease severity (disease activity score-28), and presence of subcutaneous nodules ( P < 0.05). Conclusion: Patients with RA, especially elderly patients, should undergo electrophysiological testing to rule out peripheral neuropathy. Electrophysiological study is a diagnostic and gold standard tool to diagnose subclinical neuropathy in patients with RA. Presence of peripheral neuropathy in these patients has been found to be significantly associated with deteriorating health status, pain scores, and presence of extra-articular manifestations.

Amyloid Proteins and Peripheral Neuropathy

“…Peripheral neuropathy is not considered as a characteristic feature of this systemic amyloid disease. However, in several chronic inflammatory diseases, notably in rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and to a lesser extent inflammatory bowel diseases, peripheral neuropathy is present in a subset of patients, and amyloid has been demonstrated in these diseases [ 58 , 163 ] (see Table 1 ). For example, in sural nerve biopsies of rheumatoid arthritis patients, perineurial thickening with amyloid was detected in 4 out of 23 patients investigated [ 163 ].…”

A Cohort Study to Determine the Prevalence of Pulmonary Manifestations in Rheumatoid Arthritis

“…The etiology of Rheumatoid arthritis (RA) is unknown, and this disease is responsible for inflammation of numerous organs and tissues [5][6]. This disease is known to target synovial joints primarily by causing symmetric affection in peripheral joints.…”

Clinical Manifestations, Pathogenesis, Diagnosis and Treatment of Peripheral Neuropathies in Connective Tissue Diseases: More Diverse and Frequent in Different Subtypes than Expected

“…Previous studies have shown that the types of PN-RA are pure sensory, distal axonal sensory-motor, mononeuritis multiplex and entrapment neuropathy [51]. However, Kaeley et al [49] found that pure motor neuropathy was not rare. Autonomic dysfunction also occurred in RA, characterized by heart rate responses to a deep breath (HRD), heart rate response to standing (HRS), blood pressure response to hand grip and sudomotor function impairment [52].…”

“…PN in RA was mainly reported as small sample sizes in cross-sectional studies in the past 5 years. Kaeley et al [49] reported that the prevalence of PN-RA was 75.3%. Interestingly, the incidence of PN varied according to the different subtypes of RA.…”