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  • Updated 01.17.2023
  • Released 12.04.2001
  • Expires For CME 01.17.2026

Rheumatoid arthritis: neurologic manifestations



Rheumatoid arthritis is a systemic autoimmune disease that can potentially affect any organ. Neurologic complications are well recognized, causing distinct increases in morbidity and mortality. Multidisciplinary conservative therapies include disease activity control with disease-modifying antirheumatic drugs, glucocorticoids, and new biological agents, in addition to symptomatic treatments such as rest, restriction of activity, moist heat, NSAIDs, gentle massage, etc. Neurologic complications of newer biological therapies and immunosuppressive drugs represent an increasing clinical challenge. Physical and occupational therapies also have a role.

Key points

• Degenerative disease of the cervical and lumbar spine is a common manifestation in rheumatoid arthritis.

• Entrapment neuropathies are common in rheumatoid arthritis, and patients with rheumatoid arthritis are at increased risk of such neuropathies compared to the general population.

• Neurologic complications of newer biological therapies and immunosuppressive drugs are an increasing concern.

Historical note and terminology

Neurologic complications of rheumatoid arthritis have been known for many years. In the 19th century Piters and Villard (53) and later Bannatyne (06) described peripheral neuropathy due to rheumatoid arthritis. Bannatyne described infiltration of small round cells in the nerve sheath, in the perivascular region, and among nerve fibers, as well as thickening of intima of blood vessels with encroachment on the vascular luminal wall (06). In 1942 Freund and colleagues reviewed the earlier reports on the rheumatoid arthritis neuropathy and reported “perineuritic nodules” in autopsied specimens of patients with rheumatoid arthritis (19). These nodules consisted of chronic inflammatory cells in peripheral nerves. However, the significance of these observations was unknown until Ball described the presence of systemic arteritis that included peripheral neuropathy, which could complicate rheumatoid arthritis (05). Three years later, Hart and colleagues reported 10 rheumatoid arthritis patients with peripheral neuropathy and attributed it to diffuse arteritis (22). Neuropathy, therefore, was considered as an important complication of rheumatoid arthritis. Lastly, Ferguson and Slocumb indicated that development of peripheral neuropathy in rheumatoid arthritis has prognostic values (18). In their view, rheumatoid arthritis patients with peripheral neuropathy due to vasculitis had decreased survival compared to patients without neuropathy. With introduction of modern neurology in the last 25 years, other neurologic complications of rheumatoid arthritis such as cerebral vasculitis and cervical myelopathy have also been recognized.

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