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[Rheumatoid meningitis without arthritis presenting as widespread symmetrical high-‍intensity lesions along cerebral

Takanobu Kita1, Hiroaki Okada1, Seiji Takenouchi2

  • 1Department of Neurology, Ichinomiya-Nishi Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|December 18, 2024
PubMed

Insights

Rheumatoid meningitis, a rare condition, can be diagnosed using anti-cyclic citrullinated peptide antibodies (ACPA) levels, even without arthritis. Testing ACPA and the ACPA index aids diagnosis and treatment monitoring.

Area of Science:

  • Neurology
  • Rheumatology
  • Immunology

Background:

  • Rheumatoid meningitis is an uncommon neurological complication of rheumatoid arthritis.
  • Diagnosis can be challenging, particularly in patients without overt arthritis.
  • Cerebral involvement in rheumatoid arthritis necessitates accurate diagnostic markers.

Purpose of the Study:

  • To investigate the utility of anti-cyclic citrullinated peptide antibodies (ACPA) in diagnosing rheumatoid meningitis.
  • To evaluate the ACPA index in serum and cerebrospinal fluid (CSF) for diagnostic and therapeutic assessment.
  • To highlight a case of rheumatoid meningitis successfully treated with immunotherapy.

Main Methods:

  • Case presentation of a 52-year-old woman with neurological symptoms.
  • Magnetic Resonance Imaging (MRI) with diffusion-weighted imaging (DWI) for neuroimaging.
  • Analysis of serum and CSF for anti-cyclic citrullinated peptide antibodies (ACPA) and calculation of the ACPA index.
  • Brain biopsy for histopathological confirmation.
  • Treatment with high-dose corticosteroids (steroid pulse therapy) and subsequent maintenance therapy.

Main Results:

  • MRI revealed characteristic symmetrical high-intensity lesions in the cerebral hemispheres on DWI.
  • Elevated ACPA levels in serum and CSF, along with an elevated ACPA index, supported the diagnosis.
  • Brain biopsy confirmed inflammatory cell infiltration in the subarachnoid space, indicative of rheumatoid meningitis.
  • The patient achieved full recovery following immunotherapy.

Conclusions:

  • Anti-cyclic citrullinated peptide antibodies (ACPA) testing and ACPA index evaluation are valuable tools for diagnosing rheumatoid meningitis, especially in non-arthritic patients.
  • These immunological markers can aid in assessing therapeutic efficacy.
  • Prompt diagnosis and appropriate treatment, such as steroid pulse therapy, lead to favorable outcomes in rheumatoid meningitis.
Keywords:
ACPAACPA indexDWI high-intensity lesionsRheumatoid meningitisbilateral symmetrical cerebral lesions

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