Rheumatoid arthritis presenting as rheumatoid meningitis: A case report

Jessee, Ryan C.; Keenan, Robert T.

doi:10.5430/crim.v4n3p17

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…If an extrinsic factor is present, such as an infectious event that can induce general T and/or B cell activation before development of RM, symptoms related to RA and MG will likely worsen along with elevation of immunological markers for those disorders. The good response of clinical symptoms, as well as improvement in ESR and CRP following administration of a moderate dose of corticosteroids alone in the present case and others [ 4 ], is similar to polymyalgia rheumatica. However, in our patient, no painful symptoms except for headache were noted during the entire course of illness.…”

Section: Discussionsupporting

confidence: 83%

“…Development of rheumatoid meningitis (RM), a rare autoimmune inflammatory disease of the central nervous system (CNS), is often seen in well-controlled rheumatoid arthritis (RA) patients [ 1 , 2 ] or even manifested as the first symptom in patients with RA [ 3 , 4 ]. We treated a young woman diagnosed with myasthenia gravis (MG) and RA, who presented with meningitis and transient sensory disturbance during a remission phase of both disorders.…”

Section: Introductionmentioning

confidence: 99%

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Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry

Oono

Fujita

Uchida

et al. 2018

J Neuroinflammation

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BackgroundRheumatoid meningitis (RM) is a rare disorder that often develops during a remission phase of rheumatoid arthritis (RA). This is the first study to demonstrate differences in regard to immunological disturbance between blood and cerebrospinal fluid (CSF) samples obtained from a patient with RM using flow cytometry.Case presentationA 36-year-old woman with RA and generalized myasthenia gravis (MG) developed RM during a remission phase. Although both RA and MG were stable and well controlled, she noticed fever, headache, and transient sensory disturbance. Blood and CSF examination findings suggested aseptic meningitis, while brain magnetic resonance imaging revealed restricted portions of meningitis and associated cortical lesions, compatible with a diagnosis of RM. The dose of oral prednisolone was increased, which ameliorated the symptoms within 1 week along with improvement in CSF findings. This patient exhibited features of RM that were manifested in a manner independent of the activity of RA. An investigation of cellular immunity using CSF specimens with flow cytometry showed differences in regard to the pathogenesis of inflammation in the CSF as compared to outside of the central nervous system. In contrast to results obtained with paired blood samples, CSF cells at the peak stage of RM showed a marked increase in CCR3+ Th2 cells and marked decrease in CD8+ cells, suggesting an immunoregulatory disturbance in the CSF. Those findings indicated a CSF-specific activation of humoral immunity, resulting in augmentation of meningeal inflammation, as shown by excess synthesis of intrathecal IgG and markedly elevated interleukin-6 level. Results of the present detailed investigation of lymphocyte subsets revealed a discrepancy regarding the process of inflammation in this RM patient between CSF and blood samples.ConclusionsRM is not a simple reflection of the immune status of RA, as the pathogenesis seems related to, at least in part, CSF-specific immunological dysregulation.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry

Oono

Fujita

Uchida

et al. 2018

J Neuroinflammation

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“…Overall, the preponderance of plasma cells helps distinguish RME from other connective tissue disorders [6–15].…”

Section: Discussionmentioning

confidence: 99%

“…It is controversial whether corticosteroids alone are enough to induce remission. The combination of steroids and intermittent cyclophosphamide therapies were effective in some cases [15]. Rituximab alone or in combination with leflunomide has been a successful alternative to high-dose steroids [1, 16].…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid Meningoencephalitis: A Feared Condition in the Era of TNF Blockers

Rodriguez

Minkyung

Jinna

et al. 2018

Case Reports in Rheumatology

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Central nervous system (CNS) involvement in rheumatoid arthritis (RA) is uncommon, and most of the times, it is secondary to vasculitic processes or extra-articular rheumatoid nodules. Meningeal involvement is extremely rare. In the literature, there are a few case reports, series, and retrospective studies which have demonstrated the association of rheumatoid (aseptic) meningoencephalitis after starting tumor necrosis factor (TNF) inhibitors. We present a case of rheumatoid meningoencephalitis (RME) in a 52-year-old male with a history of RA on adalimumab who presented with headaches associated with motor and sensory deficits, all of which resolved after this diagnosis was achieved and received appropriate therapy with high-dose glucocorticoids. We also present an update with high yield points summarizing clinical features, diagnostic workup, and management of RME. Finally, we post a literature review of relevant CNS rheumatoid disease in patients with and without exposure to TNF inhibitors.

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“…Some other cases have incorporated an anti-TNF agent as part of the maintenance treatment; in three patients full recovery was reported [33,40,41] and in one case a partial recovery [42].…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid meningitis: A systematic review and meta‐analysis

Villa

Sarquis

Grazia

et al. 2021

Euro J of Neurology

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Rheumatoid arthritis (RA) is a systemic inflammatory disease that commonly presents with inflammation and pain in the joints but may also cause extra-articular manifestations affecting different organs, including the central nervous system (CNS). Neurological manifestations have been classically classified in CNS vasculitis, rheumatoid nodules (RNs) and rheumatoid meningitis (RM) [1,2]. RM was first

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Rheumatoid arthritis presenting as rheumatoid meningitis: A case report

Cited by 8 publications

References 13 publications

Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry

Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry

Rheumatoid Meningoencephalitis: A Feared Condition in the Era of TNF Blockers

Rheumatoid meningitis: A systematic review and meta‐analysis

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