RESEARCH - A clinical, electrophysical, and pathological study of neuropathy in RA

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Clin Rheumatol. 2008 Jul;27(7):841-4. Epub 2007 Dec 15.

A clinical, electrophysiological, and pathological study of neuropathy

in rheumatoid arthritis.

Agarwal V, Singh R, Wiclaf , Chauhan S, Tahlan A, Ahuja CK, Goel D, Pal L.

Department of Clinical Immunology, Sanjay Gandhi Postgraduate

Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India.

Neuropathy in rheumatoid arthritis (RA) may result secondary to

entrapment, vasculitis, and drug toxicity. We aimed to study clinical

and electrophysiological neuropathy and pathological changes in sural

nerve in patients with RA. One hundred eight patients of RA,

fulfilling American College of Rheumatology 1987 criteria (mean age,

45.83 years; M/F 1:3, 80.3% seropositive) were examined clinically and

electrophysiologically for evidence of peripheral neuropathy. Sural

nerve biopsies were performed in the involved cases. In all RA patient

medications, disease activity, results of blood tests, and X-rays of

affected joints were recorded. Twenty-three patients complained of

paresthesias in the extremities. Vibration sensations were decreased

in 9, and tendon reflexes were decreased or absent in 28 patients.

Sixty-two (57.4%) patients had electrophysiologic evidence of

neuropathy. Of these 53 (85.5%) patients had pure sensory or sensory

motor axonal neuropathy (mononeuritis multiplex, n = 7), while 9

(14.5%) had demyelinating neuropathy (chronic inflammatory

demyelinating polyneuropathy, n = 1). Carpal tunnel syndrome was seen

in 11 (10.1%) patients (associated with neuropathy in 6). Of 23 sural

nerve biopsies available, perineurial thickening (n = 5, amyloid

deposits n = 4), perivascular lymphomononuclear cell infiltrate (n =

4), loss of myelin fibers (n = 2), and necrotizing vasculitis (n = 1)

were found. Clinically, however, seven patients had evidence of

cutaneous vasculitis. Comparing the clinical characteristics of the

patients with or without electrophysiological neuropathy, absence of

deep tendon jerks (p < 0.005) and presence of extra articular

manifestations (p < 0.01) were conspicuous in the neuropathic group.

There was no relation of neuropathy with the duration of RA,

seropositivity, joint erosions, joint deformities, prior

disease-modifying anti-rheumatic drugs or glucocorticoid intake, and

28-joint disease activity score. Neuropathy in RA was mostly

subclinical and predominantly axonal. Pathologically, neuropathy

secondary to amyloid infiltration was second only to vasculitic

neuropathy. Absence of deep tendon jerks and presence of vasculitis

were more commonly observed in patients with neuropathy.

PMID: 18084807

http://www.ncbi.nlm.nih.gov/pubmed/18084807

Not an MD