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Cerebral vasculitis complicating rheumatoid arthritis
J D Singleton1, S G West, V V Reddy
1Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045-5001, USA.
Southern Medical Journal
|April 1, 1995
Summary
Central nervous system vasculitis is a rare complication of rheumatoid arthritis. This case highlights the importance of neuroimaging in diagnosing this condition, even with normal initial tests.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
- Central nervous system (CNS) involvement in RA, such as vasculitis, is uncommon.
- Early diagnosis and treatment are crucial for managing CNS complications.
Observation:
- A 55-year-old woman with a 7-year history of seropositive, nodular rheumatoid arthritis presented with neurological symptoms.
- Magnetic resonance imaging (MRI) revealed multifocal white matter abnormalities suggestive of vasculitis.
- Cerebrospinal fluid (CSF) studies and cerebral angiography were normal, complicating the diagnosis.
Findings:
- Despite normal initial investigations, cerebral vasculitis was diagnosed based on MRI findings.
- Treatment with glucocorticoids and azathioprine resulted in a stable condition for 14 months.
- Postmortem examination confirmed CNS vasculitis and chronic ischemic changes.
Implications:
- This case underscores the utility of advanced neuroimaging in diagnosing CNS vasculitis in RA patients.
- It emphasizes the need for a high index of suspicion for vasculitis in RA patients with unexplained neurological deficits.
- Prompt immunosuppressive therapy may improve outcomes in CNS vasculitis associated with rheumatoid arthritis.