Rheumatoid arthritis, spondyloarthropathies, and relapsing polychondritis

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Neurologic complications in rheumatic diseases present diverse manifestations linked to specific disease pathogenesis.
• Rheumatoid arthritis (RA) commonly affects the peripheral nervous system, while central nervous system involvement is rare.
• Spondyloarthropathies, particularly ankylosing spondylitis (AS), show increased neurologic issues in advanced stages.

Purpose of the Study:

• To summarize the spectrum of neurologic complications associated with major rheumatic diseases.
• To highlight the differential involvement of the central and peripheral nervous systems in conditions like RA and AS.
• To underscore the importance of treating the underlying rheumatic disease for managing neurologic sequelae.

Main Methods:

• Review of literature on neurologic complications in rheumatoid arthritis, spondyloarthropathies, and relapsing polychondritis.
• Analysis of the relationship between disease phenotype, pathogenesis, and neurologic manifestations.
• Synthesis of information regarding treatment strategies for neurologic complications.

Main Results:

• Rheumatoid arthritis (RA) frequently involves the peripheral nervous system (mononeuritis multiplex, nerve entrapment, vasculitic neuropathy); central nervous system (CNS) complications are rare.
• TNF blockade in RA is seldom linked to demyelinating syndromes.
• Ankylosing spondylitis (AS) and other spondyloarthropathies are associated with spinal complications (atlantoaxial subluxation, cauda equina syndrome, spinal stenosis) in advanced disease; peripheral nervous system involvement is rare.
• Relapsing polychondritis (RP) involves systemic inflammation, cartilage destruction, and rare CNS vasculitis, with common visual-oculo and auditory complications.

Conclusions:

• Neurologic complications in rheumatic diseases are highly variable and depend on the specific syndrome.
• Effective management of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and relapsing polychondritis (RP) is crucial for preventing and treating associated neurologic issues.