Neuropathology of the brainstem and spinal cord in end stage rheumatoid arthritis: implications for treatment

OBJECTIVE--To study the detailed histopathological changes in the brainstem and spinal cord in nine patients with severe end stage rheumatoid arthritis, all with clinical myelopathy and craniocervical compression. METHODS--At necropsy the sites of bony pathology were related exactly to cord segments...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the rheumatic diseases 1993-09, Vol.52 (9), p.629-637
Main Authors: Henderson, F C, Geddes, J F, Crockard, H A
Format: Article
Language:English
Subjects:
Aged
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - pathology
Biological and medical sciences
Brain Stem - diagnostic imaging
Brain Stem - pathology
Diseases of the osteoarticular system
Female
Humans
Inflammatory joint diseases
Male
Medical sciences
Middle Aged
Myelography
Nervous System Diseases - diagnostic imaging
Prospective Studies
Spinal Cord - pathology
Spinal Cord Diseases - etiology
Spinal Cord Diseases - pathology
Spinal Cord Diseases - surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:OBJECTIVE--To study the detailed histopathological changes in the brainstem and spinal cord in nine patients with severe end stage rheumatoid arthritis, all with clinical myelopathy and craniocervical compression. METHODS--At necropsy the sites of bony pathology were related exactly to cord segments and histological changes, and correlated with clinical and radiological findings. RESULTS--Cranial nerve and brainstem pathology was rare. In addition to the obvious craniocervical compression, there were widespread subaxial changes in the spinal cord. Pathology was localised primarily to the dorsal white matter and there was no evidence of vasculitis or ischaemic changes. CONCLUSIONS--Myelopathy in rheumatoid arthritis is probably caused by the effects of compression, stretch, and movement, not ischaemia. The additional subaxial compression may be an important component in the clinical picture, and may explain why craniocervical decompression alone may not alleviate neurological signs.
ISSN:0003-4967
1468-2060
DOI:10.1136/ard.52.9.629