Rheumatoid arthritis with pachymeningitis – a case presentation and review of the literature

Joshi, Sanyukta; Masiak, Anna; Zdrojewski, Zbigniew

doi:10.5114/reum.2020.95368

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…Furthermore, to rule out possible infections, the cerebrospinal fluid should be negative [ 44 ]. The analysis of the pathological manifestations describes the chronic inflammation of the meninges, the concomitant presence of vasculitis, and necrotizing granulomas [ 45 ]. In some cases, but not all, the presence of ACPA and RF autoantibodies can be detected [ 46 ].…”

Section: Extra-articular Manifestations In Rheumatoid Arthritismentioning

confidence: 99%

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

et al. 2021

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Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease that affects about 1% of the global population, with a female–male ratio of 3:1. RA preferably affects the joints, with consequent joint swelling and deformities followed by ankylosis. However, evidence has accumulated showing that patients suffering from RA can also develop extra-articular manifestations, including cardiovascular disease states, neuropathies, and multiorgan dysfunction. In particular, peripheral nerve disorders showed a consistent impact in the course of the disease (prevalence about 20%) mostly associated to vasculitis of the nerve vessels leading to vascular ischemia, axonal degeneration, and neuronal demyelination. The pathophysiological basis of this RA-associated microvascular disease, which leads to impairment of assonal functionality, is still to be better clarified. However, endothelial dysfunction and alterations of the so-called brain-nerve barrier (BNB) seem to play a fundamental role. This review aims to assess the potential mechanisms underlying the impairment of endothelial cell functionality in the development of RA and to identify the role of dysfunctional endothelium as a causative mechanism of extra-articular manifestation of RA. On the other hand, the potential impact of lifestyle and nutritional interventions targeting the maintenance of endothelial cell integrity in patients with RA will be discussed as a potential option when approaching therapeutic solutions in the course of the disease.

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Section: Extra-articular Manifestations In Rheumatoid Arthritismentioning

confidence: 99%

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…RM is rarer in clinical practice, and its true prevalence is unknown. 8,9) No specific biomarkers or guidelines for detecting RM are available; hence, the diagnosis is based on a combination of clinical presentation, hematological CSF parameters, imaging findings, and the exclusion of other etiologies. 8) RM exhibits diverse MRI features, with asymmetric meningeal or leptomeningeal involvement being relatively common; 4,10) nevertheless, MRI findings alone cannot reliably differentiate between the RM and meningeal metastasis because some RM cases present with diffuse or bilateral lesions on MRI.…”

Section: Discussionmentioning

confidence: 99%

“…8,9) No specific biomarkers or guidelines for detecting RM are available; hence, the diagnosis is based on a combination of clinical presentation, hematological CSF parameters, imaging findings, and the exclusion of other etiologies. 8) RM exhibits diverse MRI features, with asymmetric meningeal or leptomeningeal involvement being relatively common; 4,10) nevertheless, MRI findings alone cannot reliably differentiate between the RM and meningeal metastasis because some RM cases present with diffuse or bilateral lesions on MRI. 11) In meningeal and leptomeningeal lesions, the concentration of Gd is lower than that in intraaxial brain lesions considering that Gd concentration is reduced as it leaks into the adjacent CSF through damaged vessels.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Rheumatoid Meningitis Diagnosed with FLAIR Images and Anti-cyclic Citrullinated Peptide Antibodies Levels

SUZUKI,

AKAMATSU,

OSHIDA

et al. 2024

NMC Case Report Journal

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Rheumatoid meningitis (RM) is a rare but serious extra-articular manifestation of rheumatoid arthritis. Due to the absence of specific biomarkers, imaging findings, or guidelines for its detection, the diagnosis of RM is difficult. This report describes a patient of RM diagnosed with an open biopsy and discusses the utility of anticyclic citrullinated peptide antibodies (ACPA) levels in the serum and cerebrospinal fluid (CSF), and contrast-enhanced (CE) fluid-attenuated inversion recovery (FLAIR) images for screening and monitoring RM. A 65-year-old woman presented with a 2-month history of headaches. Imaging studies showed asymmetric meningeal and leptomeningeal involvement seen on brain magnetic resonance imaging (MRI). An open biopsy of the meninges and leptomeninges depicted palisaded and necrotizing granulomatous inflammation, which suggests rheumatoid nodules. Treatment with prednisolone and tocilizumab led to symptom improvement and reduced lesion intensity on follow-up MRI. Throughout the treatment, the ACPA index in her serum and CSF, and the findings of CE-FLAIR images, rather than the CE T1WI, reflected disease activity. For 6 months, the patient has been stable without symptom recurrence. The ACPA index and the CE-FLAIR images were useful for the diagnosis and monitoring of RM. To validate these findings, further studies are necessary.

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“…Since these symptoms can be misinterpreted, it is necessary to make a correct diagnosis through the combination of numerous data including the objective clinical presentation, analysis of the cerebrospinal fluid obtained by lumbar puncture, MRI of the brain, and a biopsy that can exclude other etiologies. Furthermore, to rule out possible infections, the cerebrospinal fluid should be negative [43] The analysis of the pathological manifestations describes the chronic inflammation of the meninges, the concomitant presence of vasculitis, and necrotizing granulomas [44]. In some cases, but not all, the presence of ACPA and RF autoantibodies can be detected [45].…”

Section: Extra-articular Manifestations In Rheumatoid Arthritis: Neurological Involvementmentioning

confidence: 99%

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

Maiuolo¹,

Muscoli²,

Gliozzi³

et al. 2020

Preprint

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Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease that affects about 1% of the global population, with a female-male ratio of 3:1. To date, genetic predisposition, the involvement of a deficient immune system and lifestyle are known to be the major responsible for the onset of the disease. RA preferably affects the joints, with consequent joint swelling and deformities followed by ankylosis. Patients suffering from rheumatoid arthritis can also develop extra-articular manifestations, which mainly affect the cardiovascular system, the nervous system, the skin, the eye, the respiratory system, the kidney and the gastrointestinal system. It has been shown that about 20% of RA patients can develop neuropathies, multiple mononeuritis, distal sensory neuropathies and sense motor neuropathies. Neurological involvement occurs as a consequence of vasculitis of the nerve vessels leading to vascular ischaemia, axonal degeneration and neuronal demyelination. In RA, the risk of developing cardiovascular disease is very high and depends, most probably, on vascular damage resulting from endothelial dysfunction. Hence, it is reasonable to assume that the integrity of the endothelium is also involved in the neurological disorders resulting from RA. This review aims to highlight the main characteristics of the extra-articular manifestations at the nervous level resulting from rheumatoid arthritis. To this end, the literature main results on these pathological manifestations have been collected with particular focus on the involvement of endothelial dysfunction. In fact, the endothelium could be considered a valuable target for minimizing the incidence of extra-articular neurological manifestations in RA.

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Rheumatoid arthritis with pachymeningitis – a case presentation and review of the literature

Cited by 10 publications

References 36 publications

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

A Case of Rheumatoid Meningitis Diagnosed with FLAIR Images and Anti-cyclic Citrullinated Peptide Antibodies Levels

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis

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