When the plot thickens: a rare complication of rheumatoid arthritis

Abstract

Introduction : Rheumatoid arthritis (RA) is a common illness with many extraarticular manifestations. Rheumatoid pachymeningitis is a rare neurologic complication of this common disease. Here in we present a patient with longstanding RA who developed this uncommon complication. Case description : A 75-year-old woman with longstanding RA presented to the clinic with multiple seizure-like spells per day. Upon admission to the hospital, brain MRI showed enhancement of the meninges. After an extensive workup for possible other infectious or inflammatory causes, the patient was diagnosed with rheumatoid pachymeningitis. Conclusion : Rheumatoid pachymeningitis is a rare complication of RA that usually occurs late in the disease course. It may have many neurologic manifestations include mimicking seizure or stroke and must be considered in patients with RA presenting with neurologic symptoms. Pachymeningitis is treated distinctly from articular RA, so early recognition can lead to appropriate treatment.

Rheumatoid arthritis with pachymeningitis – a case presentation and review of the literature

“…Serological findings in a patient with RM include elevated CRP, ESR, RF and ACPA antibodies, out of these the latter two are considered specific, all of which were elevated in our patient [1]. ACPA antibodies titer has been a novel tool to check the disease advancement as its presence is associated with severe extra-articular manifestations and progressive damage to the joint [17].…”

“…Pachymeningitis is the inflammation of the most superficial layer of the meninges-dura mater [1]. In some cases, the inflammation can reach the leptomeninges and the brain parenchyma [3].…”

“…Preferred treatment method was intravenous methylprednisolone followed by oral prednisolone. Treatment for RA was continued or was changed to rituximab which successfully managed the RA progression [1,3,7,25,35]. Elevated serum ACE and β-2 microglobulin were reported by Pellerin et al [15] and McKenna et al [8] although, these findings haven't been clearly associated with RM [8,15].…”

“…It presents with pain and stiffness of multiple joints which commonly involve proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. The disease is estimated to affect 1% of the population predominantly women [1].…”