Rheumatoid leptomeningitis:rare complication of RA

Rheumatoid leptomeningitis:rare complication of RA | Arthritis Information

Clinical Rheumatology, 05/13/09

Koide R et al. – Study describes the case of a patient with rheumatoid leptomeningitis presenting with acute-onset behavioral changes and consciousness disturbance in the early stage of rheumatoid arthritis (RA). Conclusions drawn from this study are:

Neurologic symptoms of rheumatoid leptomeningitis:

seizure, mental status change, and hemiparesis or paraparesis

Diagnosis:

All infectious causes should be ruled out, and a brain biopsy is usually required to make the diagnosis
Following features in pts with RA may help in differential diagnosis of meningitis:
1. High-signal-intensity lesions in the subarachnoid spaces are present on FLAIR images or diffusion-weighted images
2. Leptomeningeal abnormality is a relatively focal lesion in most cases
3. Basal cisterns are usually not affected in previously reported cases (unlike tuberculosis), and
4. Response to treatment with corticosteroid is rapid
Additionally, the presence of serum anti-CCP Abs may be helpful in making the diagnosis

Successful treatment options:

corticosteroids, cyclophosphamide, and azathioprine

An early diagnosis of rheumatoid leptomeningitis and immediate initiation of treatment may prevent neurological sequelae

Rheumatoid leptomeningitis is a rare complication of rheumatoid arthritis (RA). We describe a woman with rheumatoid leptomeningitis presenting with acute-onset behavioral changes and consciousness disturbance in the early stage of RA. On fluid-attenuated inversion recovery images or diffusion-weighted images, high-signal-intensity lesions in the subarachnoid spaces of the right frontal lobe were observed. Biopsies of brain tissues and the dura mater located in the right frontal lobe were obtained. On the basis of the findings of histopathological analysis, a diagnosis of necrotizing granulomas involving the leptomeninges consistent with rheumatoid leptomeningitis was made. An early diagnosis of rheumatoid leptomeningitis and immediate initiation of treatment may prevent neurological sequelae.