Rheumatoid Arthritis: A Rare Cause of Pachymeningitis and Optic Neuritis

Area of Science:

• Neurology
• Rheumatology
• Ophthalmology

Background:

• Rheumatoid arthritis (RA) is a systemic autoimmune disease.
• Neurological complications, including pachymeningitis and optic neuritis, are rare in RA patients.
• These conditions are often diagnoses of exclusion.

Purpose of the Study:

• To report a case of a patient with rheumatoid arthritis who developed both pachymeningitis and optic neuritis.
• To highlight the importance of considering RA in the differential diagnosis of these neurological conditions.
• To illustrate the effectiveness of steroid treatment for these rare RA manifestations.

Main Methods:

• A case study of a 75-year-old male with seronegative RA presenting with eye pain and vision loss.
• Diagnostic workup included physical examination, laboratory tests (CRP, ESR), CT angiogram, MRI of the brain and orbit, and lumbar puncture.
• Treatment involved intravenous labetalol, pulse methylprednisolone, and oral prednisone.

Main Results:

• MRI revealed inflammation of the optic nerve and pachymeningitis.
• Lumbar puncture showed elevated glucose and protein, indicating an inflammatory process.
• The patient experienced significant symptom improvement with high-dose steroid therapy.

Conclusions:

• Rheumatoid pachymeningitis and optic neuritis are rare but significant neurological complications of RA.
• RA should be considered in the differential diagnosis of patients presenting with optic neuritis and pachymeningitis, even without a prior RA diagnosis.
• High-dose steroids are an effective treatment for these rare neurological manifestations of RA.