Peripheral Neuropathy in Rheumatoid Arthritis

Pallis, C; Scott, J. T.

doi:10.1136/bmj.1.5443.1141

Cited by 107 publications

(26 citation statements)

References 19 publications

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“…Hart and Golding (1960) studied the peripheral nerves in five cases of rheumatoid neuropathy at necropsy and found 'demyelination' in only one patient; this was probably axonal degeneration. Areas of segmental demyelination, on the other hand, were found in the nerves of one case of distal sensory neuropathy from the series reported by Pallis and Scott (1965), but no observations were made upon the more severe cases.…”

Section: >2mentioning

confidence: 90%

“…Sural nerve biopsies were taken from three patients in group 1 and from two patients in group 2, and examined by light and electron microscopy. In addition to the nerve fibres, we were able to study the blood vessels supplying the nerves; this is particularly important as previous workers have found evidence of vasculitis in the vasa nervorum in rheumatoid neuropathy (Cruickshank, 1954;Hart and Golding, 1960;Pallis and Scott, 1965).…”

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confidence: 99%

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Rheumatoid neuropathy: a histological and electrophysiological study

1970

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY Peripheral nerves in five patients with rheumatoid neuropathy were examined electrophysiologically and by sural nerve biopsy. There was close correlation between the clinical severity of the disease and the degree of nerve damage found histologically and by EMG. Group 1 patients with a mild distal sensory neuropathy showed varying degrees of axonal degeneration in the large myelinated fibres and some segmental demyelination. Group 2 patients with a severe, rapidly progressive sensori-motor neuropathy had extensive loss of myelinated fibres. In one case all the large fibres had degenerated. The second case had lost both large and small myelinated fibres together with many of the non-myelinated axons. The major nerve damage in both groups appeared to be axonal degeneration but some segmental demyelination was detected. Occlusive vascular disease in the vasa nervorum was considered to be the major cause of the nerve damage. Chamberlain and Bruckner (1970) GROUP 1 A patchy glove and stocking hypoaesthesia and hypoalgesia is characteristic of this group; it is approximately symmetrical, affecting the feet more often than the hands. The onset is insidious, unobtrusive, and often associated with relatively benign rheumatoid arthritis. The sex ratio is that of rheumatoid disease; with nodules and periarticular erosions frequently present. The arthritis in most patients is seropositive, the Rose's titre being only moderate. CASE 1 I.B. is a 70-year-old housewife with a 20-year history of rheumatoid arthritis. Her arthritis is seronegative, erosive, and anodular; there is typical multiple joint involvement.Mrs B. first developed paraesthesiae and hypoalgesia in the hands six years ago; the symptoms gradually increased and now involve the lower limbs. Hypoaesthesia and hypoalgesia are present on the dorsal surface of the right hallux, left hallux, and left second toe; there are sensory changes in the fingers of both hands, but the palmar aspect of the left fourth finger and the dorsal surface of the left thumb are spared. Some sensory loss can be detected in the dorsum of the right hand. The area involved has extended slightly during the last year despite bilateral carpal tunnel decompression in 1966. Although

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Section: >2mentioning

confidence: 90%

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confidence: 99%

Rheumatoid neuropathy: a histological and electrophysiological study

1970

Journal of Neurology, Neurosurgery & Psychiatry

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“…Electrophysiology in this condition produces both demyelinating and axonal features.36 Finally secondary ischaemia may play a role in the neuropathy of infective illnesses if there is obstruction to the vasa nervorum such as in the disseminated intravascular coagulation associated with a Mycoplasma pneumoniae infection; electrophysiologically this can produce both demyelinating and axonal changes. 37 The electrophysiological features in the patients with legionellosis cannot be fitted clearly into any of the above categories. The neuropathy seems characterised by a rapid loss of some motor axons causing a mild drop in conduction velocity, particularly distally, with some denervation and rapid reinnervation.…”

Section: Discussionmentioning

confidence: 99%

Neurological involvement in legionellosis

Weir

Bone

Kennedy

1982

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY A study of the clinical, electrophysiological and biochemical features of 16 patients with legionellosis has been performed. Evidence of central and peripheral nervous system involvement has been found in the majority of patients. This is characterised by confusion out of keeping with the degree of toxic or metabolic upset, signs of anterior midline cerebellar dysfunction, grossly elevated creatinine kinase of skeletal muscle origin, and a subclinical peripheral neuropathy.Since the epidemic of severe pneumonia at an American Legion Convention in 1976' the term legionnaires' disease has been associated with a serious respiratory system disorder. Infection with the causative pathogen, Legionella pneumophila is now more appropriately termed legionellosis to emphasise the multisystem features including pneumonia, abdominal distension and paralytic ileus, renal impairment, shock, icterus, coagulopathy and neurological upset.'-3 In view of the difficulty of isolating the causative bacillus and the current dependence on serological testing for positive diagnosis the clinical features are crucial. This is important in view of the limited therapeutic options and high mortality in untreated cases.45The neurological aspects have been described by several workers in case reports,2 5-l1 but no comprehensive study has been made of these features. We report our findings of 16 cases of legionellosis which have been examined and investigated neurologically, out of a total of 28 which have passed through the infectious diseases and chest medicine units of Ruchill Hospital, Glasgow. We have briefly communicated our findings before'617 and two of the cases reported have also been described previously by Lees and Tyrrell.

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“…Patients with rheumatoid arthritis can also develop a symmetrical, sensory peripheral neuropathy involving the hands and legs in a glove and stocking distribution [12]. This is distinct from the rarer and more severe sensorimotor mononeuritis multiplex mentioned above which is associated with motor paralysis presenting with wrist and foot drop.…”

Section: Neuropathymentioning

confidence: 97%

Vascular and neurological considerations in rheumatoid arthritis

Hayton

2006

International Congress Series

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Peripheral Neuropathy in Rheumatoid Arthritis

Cited by 107 publications

References 19 publications

Rheumatoid neuropathy: a histological and electrophysiological study

Rheumatoid neuropathy: a histological and electrophysiological study

Neurological involvement in legionellosis

Vascular and neurological considerations in rheumatoid arthritis

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