Neurological Manifestations in Rheumatoid Arthritis.

Arul Rajamurugan, P S (2007) Neurological Manifestations in Rheumatoid Arthritis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Rheumatoid arthritis (RA) is a chronic multisystem disease of autoimmune aetiology. The characteristic feature is the persistent inflammatory synovitis usually involving peripheral joints in a symmetric distribution. Though it is considered a disease predominantly involving the joints it can cause a variety of extraarticular manifeststions.It can affect skin,eye,cardiovascular ,respiratory and nervous systems and may produce hematological complications including an increase in the risk of Hodgkin’s disease,non Hodgkin’s lymphomas, leukemias independent of the immunosuppressive drugs. One of the important extra articular manifestations is the involvement of nervous system. Neurological manifestations may be due to the involvement of central nervous system involvement, peripheral nervous system or autonomic nervous system. They may be either due to the vascular involvement, direct compression or immune mediated mechanism. It is often difficult to diagnose early neuropathies and the study of the peripheral nervous system is made difficult by symptoms resulting from pain in the joints and limitations of movement. It is nevertheless often possible by means of electroneuromyography to show objectively the existence and distribution of even subclinical neuropathies. AIMS AND OBJECTIVES : 1. To study the various neurological manifestations in patients with rheumatoid arthritis. 2. To assess the subclinical neuropathy using the neurophysiological studies. 3. To correlate neurological involvement with Rheumatoid factor positivity and the DAS 28 score. MATERIALS AND METHODS : Sixty eight consecutive patients (15 males, 53 females) with rheumatoid arthritis who attended the department of rheumatology, Madras Medical College were included as the study population. This a prospective study done during September 2004 -April 2007. Thirty four age and sex matched persons were taken as controls for the autonomic function testing. Inclusion criteria: Patients who fulfilled 1988 revised American Rheumatism Association criteria for rheumatoid arthritis. Exclusion criteria: 1. Age above 60 years, 2). Endocrine and metabolic disorders, 3. Hypertension, 4. Treatment with drugs influencing the adrenergic nervous system, 5. Liver, renal, respiratory and cardiac diseases, 6. Pregnancy, 7. Severe anemia. Methods : All the selected patients were subjected for detailed clinical examination. Hematological evaluation included complete hemogram and peripheral smear study. Biochemical parameters including blood glucose, urea, serum creatinine, liver function tests and fasting lipid profile Immunological evaluation included rheumatoid factor and CRP by latex agglutination method, ANA by Indirect immunofluorescence using the mouse liver substrate and Hep 2 cells if negative by mouse liver substrate Cryoglobulin was tested by preparing the centrifuged serum, keeping it at 40C and reading it after 72 hours. Anticardiolipin antibodies Ig G and Ig M by ELISA and Lupus anticoagulant tests activated partial prothrombin time, dilute Russel viper venom test and Kaolin clotting time were done if appropriate. Radiological evaluation included X-Rays of the hands, feet, and cervical spine AP, lateral flexion and neutral, skull AP open mouth views. CT scan and MR Imaging were done if the patients had neurological signs or symptoms. Nerve conduction study was done for all patients. RESULTS : A total of 68 patients were evaluated. The male, female ratio was1: 3.5, the mean age was 39.5 yrs. Mean duration of the disease was 3.6 yrs. Out of 68 patients 27 (male-3, female-24) patients had neurological symptoms in the form of paraesthesia of the hands and feet, numbness, weakness or radicular pain. Seven patients had signs of neurological involvement on clinical examination. Two patients had quadriparesis due to cord compression. One patient had lateral medullary syndrome. Two patients had absent ankle jerk. Two patients had positive Tinel’s sign due to carpal tunnel syndrome. One patient had rheumatoid nodules, 10 patients had deformities in the form of boutonnier’s deformity in 1, swan neck deformity in 1, finger drop in 1, jaccoud’s arthropathy in 1, hallux valgus in 2,hammer toes in 1, instability of the knees in 2, foot drop in 1. Two patients had quadriparesis due to cord compression. CONCLUSION : There was a female predominance in the patients with neurological manifestations due to rheumatoid arthritis. • Autonomic nervous system dysfunction was the commonest manifestation. • Among the peripheral nerve lesions carpal tunnel syndrome was the commonest lesion. • One patient had subclinical neuropathy. • Cervical myelopathy due to atlantoaxial subluxation alone correlated with the duration of the disease. • Rheumatoid factor positivity was not associated significantly with the CNS and PNS lesions. • Active disease was seen in 66% of patients with central nervous system involvement, 75% of patients with peripheral nervous system involvement and 94% of patients with autonomic dysfunction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neurological Manifestations ; Rheumatoid Arthritis.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:48
Last Modified: 16 Aug 2017 07:16

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