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Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis

OBJECTIVE: To describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. METHODS: The patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. RESULTS: Six patients with RM were identified among 933 p...

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Autores principales: Fan, Siyuan, Zhao, Jiuliang, Hou, Bo, Liu, Mange, Niu, Jingwen, Zhou, Yan, Mao, Chenhui, Ren, Haitao, Feng, Feng, Li, Mengtao, Zeng, Xiaofeng, Zhu, Yicheng, Guan, Hongzhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10282747/
https://www.ncbi.nlm.nih.gov/pubmed/37350975
http://dx.doi.org/10.3389/fimmu.2023.1065650
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author Fan, Siyuan
Zhao, Jiuliang
Hou, Bo
Liu, Mange
Niu, Jingwen
Zhou, Yan
Mao, Chenhui
Ren, Haitao
Feng, Feng
Li, Mengtao
Zeng, Xiaofeng
Zhu, Yicheng
Guan, Hongzhi
author_facet Fan, Siyuan
Zhao, Jiuliang
Hou, Bo
Liu, Mange
Niu, Jingwen
Zhou, Yan
Mao, Chenhui
Ren, Haitao
Feng, Feng
Li, Mengtao
Zeng, Xiaofeng
Zhu, Yicheng
Guan, Hongzhi
author_sort Fan, Siyuan
collection PubMed
description OBJECTIVE: To describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. METHODS: The patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. RESULTS: Six patients with RM were identified among 933 patients admitted with rheumatoid arthritis (RA). The symptoms of meningitis occurred after onset of arthritis in five patients and before onset in one. Headache (n=6), hyperacute focal neurological deficits (n=4) and seizures (n=3) were the most prevalent symptoms. The nadir modified Rankin Scale score was ≥3 in five patients. Rheumatoid factor was elevated in all patients, and interleukin-6 levels in cerebrospinal fluid were dramatically elevated in three of four tested patients. Magnetic resonance imaging of the brain revealed that the meninges were affected in all patients and the cerebral parenchyma was affected in one patient. The lesions were generally located in the frontoparietal region and showed restricted diffusion along the adjacent subarachnoid space. RM occurred during disease-modifying therapy in four patients. In the acute episode, three patients improved on tocilizumab and the other three improved on pulse corticosteroids. For maintenance therapy, two patients received combined therapy of tocilizumab and other immunosuppressive agents, one received adalimumab and methotrexate, and two received low-dose oral corticosteroids with an immunosuppressive agent. Five patients had a good outcome, and one died of Pneumocystis jirovecii pneumonia after stabilization of his neurologic conditions. No relapse of RM occurred on immunotherapy during follow-up. CONCLUSIONS: Chinese patients with RM share some remarkable clinical and neuroimaging features and respond well to appropriate immunotherapy. Tocilizumab could be a treatment option for this severe complication of RA.
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spelling pubmed-102827472023-06-22 Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis Fan, Siyuan Zhao, Jiuliang Hou, Bo Liu, Mange Niu, Jingwen Zhou, Yan Mao, Chenhui Ren, Haitao Feng, Feng Li, Mengtao Zeng, Xiaofeng Zhu, Yicheng Guan, Hongzhi Front Immunol Immunology OBJECTIVE: To describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. METHODS: The patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. RESULTS: Six patients with RM were identified among 933 patients admitted with rheumatoid arthritis (RA). The symptoms of meningitis occurred after onset of arthritis in five patients and before onset in one. Headache (n=6), hyperacute focal neurological deficits (n=4) and seizures (n=3) were the most prevalent symptoms. The nadir modified Rankin Scale score was ≥3 in five patients. Rheumatoid factor was elevated in all patients, and interleukin-6 levels in cerebrospinal fluid were dramatically elevated in three of four tested patients. Magnetic resonance imaging of the brain revealed that the meninges were affected in all patients and the cerebral parenchyma was affected in one patient. The lesions were generally located in the frontoparietal region and showed restricted diffusion along the adjacent subarachnoid space. RM occurred during disease-modifying therapy in four patients. In the acute episode, three patients improved on tocilizumab and the other three improved on pulse corticosteroids. For maintenance therapy, two patients received combined therapy of tocilizumab and other immunosuppressive agents, one received adalimumab and methotrexate, and two received low-dose oral corticosteroids with an immunosuppressive agent. Five patients had a good outcome, and one died of Pneumocystis jirovecii pneumonia after stabilization of his neurologic conditions. No relapse of RM occurred on immunotherapy during follow-up. CONCLUSIONS: Chinese patients with RM share some remarkable clinical and neuroimaging features and respond well to appropriate immunotherapy. Tocilizumab could be a treatment option for this severe complication of RA. Frontiers Media S.A. 2023-06-07 /pmc/articles/PMC10282747/ /pubmed/37350975 http://dx.doi.org/10.3389/fimmu.2023.1065650 Text en Copyright © 2023 Fan, Zhao, Hou, Liu, Niu, Zhou, Mao, Ren, Feng, Li, Zeng, Zhu and Guan https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Fan, Siyuan
Zhao, Jiuliang
Hou, Bo
Liu, Mange
Niu, Jingwen
Zhou, Yan
Mao, Chenhui
Ren, Haitao
Feng, Feng
Li, Mengtao
Zeng, Xiaofeng
Zhu, Yicheng
Guan, Hongzhi
Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title_full Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title_fullStr Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title_full_unstemmed Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title_short Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
title_sort rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10282747/
https://www.ncbi.nlm.nih.gov/pubmed/37350975
http://dx.doi.org/10.3389/fimmu.2023.1065650
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