Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis
ObjectiveTo describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. MethodsThe patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. ResultsSix patients with RM were identified among 933 patient...
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| Format: | Article |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1065650/full |
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| author | Siyuan Fan Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Bo Hou Mange Liu Jingwen Niu Yan Zhou Chenhui Mao Haitao Ren Feng Feng Mengtao Li Mengtao Li Mengtao Li Mengtao Li Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Yicheng Zhu Hongzhi Guan |
| author_facet | Siyuan Fan Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Bo Hou Mange Liu Jingwen Niu Yan Zhou Chenhui Mao Haitao Ren Feng Feng Mengtao Li Mengtao Li Mengtao Li Mengtao Li Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Yicheng Zhu Hongzhi Guan |
| author_sort | Siyuan Fan |
| collection | DOAJ |
| description | ObjectiveTo describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. MethodsThe patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. ResultsSix 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. ConclusionsChinese 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. |
| first_indexed | 2024-03-13T06:58:28Z |
| format | Article |
| id | doaj.art-eca339274ee24fd085dd0875ffdc9a00 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-13T06:58:28Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-eca339274ee24fd085dd0875ffdc9a002023-06-07T05:14:24ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-06-011410.3389/fimmu.2023.10656501065650Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritisSiyuan Fan0Jiuliang Zhao1Jiuliang Zhao2Jiuliang Zhao3Jiuliang Zhao4Bo Hou5Mange Liu6Jingwen Niu7Yan Zhou8Chenhui Mao9Haitao Ren10Feng Feng11Mengtao Li12Mengtao Li13Mengtao Li14Mengtao Li15Xiaofeng Zeng16Xiaofeng Zeng17Xiaofeng Zeng18Xiaofeng Zeng19Yicheng Zhu20Hongzhi Guan21Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaNational Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Beijing, ChinaState Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, ChinaKey Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, ChinaDepartment of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaNational Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Beijing, ChinaState Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, ChinaKey Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, ChinaDepartment of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaNational Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science and Technology, Beijing, ChinaState Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, ChinaKey Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaObjectiveTo describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. MethodsThe patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. ResultsSix 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. ConclusionsChinese 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.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1065650/fullrheumatoid arthritisrheumatoid meningitisimmunotherapytocilizumab (TCZ)neuroimage |
| spellingShingle | Siyuan Fan Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Jiuliang Zhao Bo Hou Mange Liu Jingwen Niu Yan Zhou Chenhui Mao Haitao Ren Feng Feng Mengtao Li Mengtao Li Mengtao Li Mengtao Li Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Xiaofeng Zeng Yicheng Zhu Hongzhi Guan Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis Frontiers in Immunology rheumatoid arthritis rheumatoid meningitis immunotherapy tocilizumab (TCZ) neuroimage |
| 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 | rheumatoid arthritis rheumatoid meningitis immunotherapy tocilizumab (TCZ) neuroimage |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1065650/full |
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