Neurologic manifestations of rheumatoid arthritis
What are the major neurologic manifestations of rheumatoid arthritis (RA)?
The major sequelae of RA are typically limited to the peripheral nervous system due to nerve entrapment near inflamed joints, perineural inflammation and demyelination of sensory nerves, and vasculitic destruction of large nerves giving rise to an asymmetric sensorimotor neuropathy.
Diffuse nodular polymyositis may occur in 30% of patients with RA, although classic polymyositis is rare (5%).
Focal ischemic myositis occurs as a result of a vasculitic attack on the muscle vasculature.
CNS manifestations are rare and include a polyarteritis nodosa (PAN)-like vasculitis affecting cerebral vasculature, hyperviscosity syndrome producing focal ischemic and hemorrhagic CNS lesions, and rheumatoid cervical spine disease with myelopathy most commonly occurring at C4-C5.
Compression or laceration of the spinal cord may be the direct result of impaction or subluxation of one or more vertebral bodies or rings against the cord.
Vascular compression syndromes may also be found in RA patients with cervical disease, especially involving the anterior spinal artery.
These syndromes lead to ischemic central gray matter destruction and to necrosis of the dorsal columns and corticospinal tracts.
