Neurologic Manifestations of Rheumatoid Arthritis: A Case of Cerebral Vasculitis Treated With Rituximab

Rida, Mohamad Ali; Najjar, Maysam El; Merashli, Mira

doi:10.5606/archrheumatol.2019.6938

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Twenty-six cases of adult onset CRV have been reported thus far ( 5 - 27 ), as shown in Table . Although the mean duration of RA was long (15.9 years), cases of RA lasting less than 10 years, such as the present, are not rare (7 cases, 29%), and in such cases, the level of rheumatoid factor was relatively high (mean 585 IU/mL).…”

Section: Discussionmentioning

confidence: 99%

Possible Cerebral Vasculitis in a Case with Rheumatoid Arthritis

Takeuchi¹,

Murahashi²,

Hara³

et al. 2021

Intern. Med.

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Cerebral rheumatoid vasculitis (CRV) is a rare, fatal, and diagnostically challenging disorder. We herein report an 81-year-old woman with a 4-year history of rheumatoid arthritis who presented with a fever, progressive disturbance of consciousness, high level of rheumatoid factor, and hypocomplementemia. The enhancement of the perforating branches in the left middle cerebral artery led us to suspect CRV. A brain biopsy could not be performed. After we intensified steroid therapy, the size of the cerebral lesions temporarily decreased. However, recurrence in the left frontal lobe occurred one month later, and the patient subsequently died. Early intensive treatments may be needed for CRV.

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Section: Discussionmentioning

confidence: 99%

Possible Cerebral Vasculitis in a Case with Rheumatoid Arthritis

Takeuchi¹,

Murahashi²,

Hara³

et al. 2021

Intern. Med.

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Diffusion tensor imaging analysis of rheumatoid arthritis patients with neuropsychiatric features to determine the alteration of white matter integrity due to vascular events

et al. 2022

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Rheumatoid Cerebral Vasculitis in a Patient in Remission

Hasbani

Ouweini

Dabdoub

et al. 2022

Clin Med Insights Case Rep

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Cerebral vasculitis is a very rare extra-articular complication of rheumatoid arthritis (RA) that is often challenging to diagnose. Elevated titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antinuclear antibodies (ANA) have been linked with severe complications. The absence of highly elevated titers of RF, anti-CCP, and ANA can complicate the diagnosis of RA-associated cerebral vasculitis. We report the case of a 59-year-old woman with long-standing arthritis maintained on rituximab and leflunomide who developed sudden headaches and altered level of consciousness. Laboratory work-up revealed normal lymphocyte count and mildly elevated total serum protein and anti-CCP with negative RF and ANA and no evidence for viral or bacterial infections. Cerebrospinal fluid analysis (CSF) showed slightly elevated anti-CCP with normal levels of CXCL-13 and interleukin 6 (IL-6). Brain magnetic resonance imaging (MRI) showed ill-defined lesion of high T2 signal. Using MR angiogram, MR perfusion, and MR spectroscopy, the diagnosis of rheumatoid cerebral vasculitis was confirmed. The patient was treated with intravenous methyl-prednisolone with fast complete improvement. We conclude that adequate immunosuppression in RA might not be able to prevent rare extra-articular manifestations such as rheumatoid cerebral vasculitis.

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Neurologic Manifestations of Rheumatoid Arthritis: A Case of Cerebral Vasculitis Treated With Rituximab

Cited by 3 publications

References 6 publications

Possible Cerebral Vasculitis in a Case with Rheumatoid Arthritis

Possible Cerebral Vasculitis in a Case with Rheumatoid Arthritis

Diffusion tensor imaging analysis of rheumatoid arthritis patients with neuropsychiatric features to determine the alteration of white matter integrity due to vascular events

Rheumatoid Cerebral Vasculitis in a Patient in Remission

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