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[Rheumatoid arthritis and meningeal nodules]

B Richioud1, Y Béjot, P Ornetti

  • 1Service de neuroradiologie, CHU de Dijon, 3, rue Faubourg-Raines, 21033 Dijon cedex, France.

Revue Neurologique
|March 2, 2012
PubMed
Abstract

Insights

Meningeal rheumatoid nodules, rare in rheumatoid arthritis, were observed in a patient with visual impairment. These lesions showed characteristic changes on MRI over four years, confirming the diagnosis.

Area of Science:

  • Neurology
  • Rheumatology
  • Radiology

Background:

  • Rheumatoid nodules are uncommon extra-articular manifestations of rheumatoid arthritis.
  • While typically subcutaneous, these nodules can rarely affect deep organs, including the meninges.

Observation:

  • A case of a 52-year-old man with rheumatoid arthritis presenting with acute visual impairment due to meningeal nodules is described.
  • Brain MRI revealed new nodular lesions with regression of initial ones, followed by complete involution over four years.

Findings:

  • The observed radiological changes, including lesion development and regression, were highly suggestive of meningeal rheumatoid nodules.
  • The patient's treatment with low-dose methotrexate, insufficient to cross the blood-brain barrier, indicated the lesions developed due to the natural disease course.

Implications:

  • This case highlights the importance of considering meningeal rheumatoid nodules in rheumatoid arthritis patients with neurological symptoms.
  • Serial MRI monitoring is crucial for diagnosing and characterizing these rare lesions, even with initially non-specific findings.

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