Thoracic Myelopathy Due to Intraspinal Rheumatoid Nodules

Abstract

A fifty-six-year-old woman with classical rheumatoid arthritis had subacute onset of paraparesis due to thoracic epidural rheumatoid nodules. Although plain radiograms and computed tomograms of the thoracic spine were negative except for old compression fractures, magnetic resonance imaging revealed thoracic spinal cord compression due to masses at multiple levels. There was a steady recovery after excision surgery.

Early Intervention Results in Lower Mortality in Patients with Cancer Hospitalized for Metastatic Spinal Cord Compression

“…11 12 Other entities which may mimic MSCC are infiltrative disease (sarcoidosis), gout, arthritis of the spine, extramedullary hematopoiesis, meningiomas, hemangiomas, epidural hematomas, etc. [13][14][15][16][17][18] Patients often present with a history of back pain which starts ∼2 months earlier which in the setting of generalized weakness, presence of prior neurological deficits and concomitant severe cancer pain may confound the presentation of MSCC. 19 Dexamethasone is often used in the acute setting to help alleviate vasogenic edema.…”

“…Both of these imaging techniques also help in distinguishing MSCC from radiation myelopathy, an entity which may have a similar clinical presentation 11 12. Other entities which may mimic MSCC are infiltrative disease (sarcoidosis), gout, arthritis of the spine, extramedullary hematopoiesis, meningiomas, hemangiomas, epidural hematomas, etc 13-18…”

Polyarthrite rhumatoïde

“…Ils peuvent se rompre en simulant une phlébite (mais celleci peut être présente en raison de la compression) . On signalera également la possibilité de nodules rhumatoïdes épiduraux et méningés, potentiellement compressifs pour les émergences radiculaires et la moelle [166,204,354,398] . Inversement, ils peuvent être découverts par l'imagerie, notamment à la face plantaire du calcanéus .…”

Rheumatoid Hydrocele

“…There are numerous case reports citing evidence of rheumatoid nodular and non-nodular inflammation involving more unusual locations such as the nasal septum, 1 larynx, 2 trachea, 3 pulmonary tree, 4 pericardium, 5 and mitral and aortic valves. 6,7 Even intraspinal nodules have been identified 8 and sometimes the symptoms from the sites of inflammation precede the articular symptoms. There are anecdotal reports of subcutaneous nodules regressing with colchicine and D-penicillamine therapy and enlarging with methotrexate.…”