Central nervous system involvement as a major manifestation of rheumatoid arthritis.
A 58-year-old woman with an 8-year history of seropositive rheumatoid arthritis was admitted with right hemiparesis, history of seizures, fever, weight loss and headaches. Her blood tests revealed the presence of rheumatoid factor, elevated C-reactive protein and anti-cyclic citrullinated peptide antibodies (>200 RU/ml). Examination of cerebrospinal fluid demonstrated pleocytosis (118 cells/mm(3), predominantly lymphocytes) with elevated protein level (58 mg/dl); cultures were negative. Magnetic resonance imaging findings were suggestive for meningoencephalitis. Short course of high-dose corticosteroids and cyclophosphamide led to clinical improvement. Rheumatoid vasculitis was probably responsible for neurological symptoms.
Zolcinski
M
M
Department of Internal Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Bazan-Socha
S
S
Zwolinska
G
G
Musial
J
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000473:pathology*; D002097:C-Reactive Protein / Q000032:analysis; D002490:Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use; D014657:Vasculitis / Q000473:pathology
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D014635:Valproic Acid; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D008775:Methylprednisolone
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