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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1903-1904

Rheumatoid Meningitis as an Extra-articular Manifestation of Rheumatoid Arthritis


1 Hospital Casa de Portugal, Rio de Janeiro, Brazil
2 Hospital Casa de Portugal; Brain Institute Paulo Niemeyer, Rio de Janeiro, Brazil
3 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Bruno Niemeyer
Brain Institute Paulo Niemeyer, Rua do Rezende, 156, Centro, Rio de Janeiro
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333442

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How to cite this article:
Franco FL, Niemeyer B, Marchiori E. Rheumatoid Meningitis as an Extra-articular Manifestation of Rheumatoid Arthritis. Neurol India 2021;69:1903-4

How to cite this URL:
Franco FL, Niemeyer B, Marchiori E. Rheumatoid Meningitis as an Extra-articular Manifestation of Rheumatoid Arthritis. Neurol India [serial online] 2021 [cited 2022 Jan 18];69:1903-4. Available from: https://www.neurologyindia.com/text.asp?2021/69/6/1903/333442




Rheumatoid meningitis (RM) is primarily, if not exclusively, a complication of seropositive rheumatoid arthritis (RA).[1] It occurs most often in long-standing RA cases and can develop in individuals whose articular disease is clinically quiescent. RA can affect all three layers of the meninges and can cause pachymeningitis (inflammation of the dura mater), leptomeningitis (inflammation the arachnoid and pia mater), or a combination of pachymeningitis and leptomeningitis.[1],[2],[3],[4] RM can be patchy or diffuse and usually affects the meninges that surround the brain rather than the spinal cord.[1],[2],[3],[4]

A 70-year-old woman with long-standing RA was admitted to our hospital with a two-week history of headache, seizures, and a reduced level of consciousness. Lumbar puncture revealed lymphocytic pleocytosis (84%) and elevated protein (79.3 g/dL). Brain magnetic resonance imaging revealed abnormal leptomeningeal and pachymeningeal thickening and enhancement of the parietal and frontal lobes with significant vasogenic edema [Figure 1]. These imaging findings and clinical and laboratory data suggested a diagnosis of RM, which was confirmed by histopathology that showed mononuclear cell infiltration with rheumatoid nodules. Although there are no clinical trials to guide treatment for RM, we treated with corticosteroids and the patient's symptoms improved.
Figure 1: MRI FLAIR (a), DWI (b) and gadolinium-enhanced T1 (c) showing frontoparietal vasogenic edema (a) with restricted diffusion (b) and leptomeningeal and pachymeningeal thickening and enhancement (c)

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RM is a rare condition and one of the most severe complications of RA, which is usually described in seropositive patients with long-standing, active RA and with extra-articular manifestations.[1],[2],[3],[4] The most common neuroimaging findings of RM are gadolinium-enhancing meninges as demonstrated in the literature.[1],[2],[3],[4]

Ethics board approval

The approval was waived because it was only a case report, and no new test or treatment was performed, and did not expose the patient to risks.

Written informed consent was obtained from the patient to publish the material.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
DeQuattro K, Imboden JB. Neurologic manifestations of rheumatoid arthritis. Rheum Dis Clin North Am 2017;43:561-71.  Back to cited text no. 1
    
2.
Hasiloglu ZI, Asik M, Erer B, Dikici AS, Altintas A, Albayram S. Magnetic resonance imaging of rheumatoid meningitis: A case report and literature review. Rheumatol Int 2012;32:3679-81.  Back to cited text no. 2
    
3.
Matsuda S, Yoshida S, Takeuchi T, Fujiki Y, Yoshikawa A, Makino S. Asymptomatic rheumatoid meningitis revealed by magnetic resonance imaging, followed by systemic rheumatic vasculitis: A case report and a review of the literature. Mod Rheumatol 2016;23:1-7.  Back to cited text no. 3
    
4.
Alexander SK, Di Cicco M, Pohl U, Cifelli A. Rheumatoid disease: an unusual cause of relapsing meningoencephalitis. BMJ Case Rep 2018. doi: 10.1136/bcr-2017-222587.  Back to cited text no. 4
    


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