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Rheumatoid meningitis: A systematic review and meta-analysis
Eduardo Villa1, Teresita Sarquis1, José de Grazia2
1Department of Neurology and Neurosurgery, Faculty of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.
European Journal of Neurology
|May 9, 2021
Summary
Rheumatoid meningitis (RM), a complication of rheumatoid arthritis (RA), presents with neurological symptoms. Early diagnosis and high-dose corticosteroid treatment improve outcomes, with a significant recovery rate observed in this systematic review.
Area of Science:
- Neurology
- Rheumatology
- Systematic Review
Background:
- Rheumatoid meningitis (RM) is a rare neurological complication of rheumatoid arthritis (RA).
- Existing evidence is limited to case reports and partial reviews, necessitating a comprehensive analysis.
Purpose of the Study:
- To systematically review and analyze the characteristics of rheumatoid meningitis.
- To describe clinical, imaging, laboratory findings, treatments, and outcomes of RM.
Main Methods:
- Systematic review and meta-analysis adhering to the PRISMA statement.
- Inclusion of 103 studies comprising 130 cases of rheumatoid meningitis.
Main Results:
- RM affects adults (average age 62) with or without prior RA diagnosis; RA activity and disease duration correlate with poorer prognosis.
- Common symptoms include focal neurological signs (64.6%), systemic symptoms (51.3%), headache (50.4%), and neuropsychiatric changes (47.7%). Joint manifestations were infrequent (27.4%).
- Elevated rheumatoid factor, anti-CCP antibodies, CRP, and ESR were common laboratory findings. CSF analysis revealed increased protein and pleocytosis. Corticosteroid pulse therapy was the primary induction treatment, with a 31.17% relapse rate and 54.54% full recovery.
Conclusions:
- Rheumatoid meningitis should be suspected in adults, with or without RA diagnosis.
- High-dose corticosteroid induction therapy is crucial; maintenance therapy is key. Anti-TNF agents are not recommended for induction.
- Timely diagnosis and treatment, particularly with corticosteroids, significantly improve RM outcomes.
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