Rheumatoid meningitis without a history of rheumatoid arthritis: a case report and literature review

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis, usually with non-specific symptoms. In most cases, head magnetic resonance imaging (MRI) shows lamellar enhancements in leptomeninges and pachymeninges, but definitive diagnosis relies on meningeal biopsies....

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Bibliographic Details
Published in:Rheumatology international 2023-06, Vol.43 (6), p.1173-1182
Main Authors: Huang, Gang, Wu, Lingfeng, Mei, Zhujun, Yao, Dongyuan
Format: Article
Language:English
Subjects:
Adult
Arthritis, Rheumatoid - drug therapy
Autoantibodies
Biopsy
Case Based Review
Case reports
Headache - etiology
Humans
Magnetic resonance imaging
Male
Medicine
Medicine & Public Health
Meningitis
Meningitis - diagnosis
Meningitis - drug therapy
Meningitis - etiology
Peptides, Cyclic - therapeutic use
Rheumatoid arthritis
Rheumatoid Factor
Rheumatology
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Summary:Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis, usually with non-specific symptoms. In most cases, head magnetic resonance imaging (MRI) shows lamellar enhancements in leptomeninges and pachymeninges, but definitive diagnosis relies on meningeal biopsies. Here, we reported a 43-year-old RM patient without a previous history of rheumatoid arthritis. He came to seek medical assistance because of fever and headache. The head MRI showed bilateral enhancements in leptomeninges and pachymeninges, and blood tests showed that serum IgM rheumatoid factor (RF) (1010.0 IU/ml) and anti-cyclic citrullinated peptide (CCP) antibody (654.24 RU/ml) became positive with a further increase with the progression of the disease. After treatment with steroids, clinical symptoms were relieved. We also reviewed previous history, symptoms, and serum, cerebrospinal fluid and imaging findings in 15 RM cases without a history of rheumatoid arthritis published since 2010. Consistent with previous reported cases, the current case suggests importance of meningeal biopsies and increases in serum RF and anti-CCP antibody in diagnosis of RM. In addition, previous joint symptoms and chronic headaches, and leptomeningeal and pachymeningeal lesions on head MRI are also of great significance for the diagnosis.
ISSN:1437-160X
0172-8172
1437-160X
DOI:10.1007/s00296-022-05209-x