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Rheumatoid meningitis: A case report and review of the literature
Purpose Of Review:
Rheumatoid arthritis is a systemic inflammatory disorder, which can involve many organs; among which, CNS involvement, as in rheumatoid meningitis (RM), is rare and difficult to recognize. Our goal is to present collective data of RM cases to better characterize this disease process and to start new discussions about pathophysiology, diagnosis, and treatment.
Recent Findings:
Since Kato et al., 39 cases of RM have been reported. Approximately 59% were women, presenting with neurologic deficits (56%) and diagnosed by MRI findings, leptomeningeal enhancement (69%), after CSF analysis. Seventy-four percent were treated with corticosteroids, 64% as maintenance therapy, with 46% experiencing improvement or resolution in symptoms without relapse.
Summary:
Diagnosis and prognosis of RM has drastically changed since the year 2000. Early detection with CSF and MRI or biopsy findings, coupled with early treatment using corticosteroids and immunologic therapy, has reduced mortality in this population.
Insights
Rheumatoid meningitis (RM) is a rare central nervous system complication of rheumatoid arthritis. Early diagnosis via CSF and MRI, followed by corticosteroid treatment, improves outcomes and reduces mortality in RM patients.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a systemic inflammatory disease.
- Central nervous system (CNS) involvement, such as rheumatoid meningitis (RM), is uncommon but serious.
- RM presents diagnostic and therapeutic challenges.
Purpose of the Study:
- To consolidate data from reported RM cases.
- To enhance understanding of RM's characteristics, pathophysiology, diagnosis, and treatment.
- To stimulate further research and discussion on RM.
Main Methods:
- Systematic review of reported rheumatoid meningitis cases since Kato et al.
- Analysis of patient demographics, clinical presentation, diagnostic findings (MRI, CSF), and treatment outcomes.
Main Results:
- 39 RM cases reported, with 59% affecting women.
- Neurologic deficits (56%) and leptomeningeal enhancement on MRI (69%) were common findings.
- Corticosteroid therapy was used in 74%, with 46% showing symptom improvement without relapse.
Conclusions:
- Diagnosis and prognosis of RM have improved significantly since 2000.
- Early detection through CSF, MRI, or biopsy is crucial.
- Prompt treatment with corticosteroids and immunotherapies reduces RM-related mortality.
