Rheumatoid arthritis complicated by peripheral neuropathy: an analysis of lesion characteristics in 5 cases

Xuejun ZENG; Min SHEN; Fulin TANG

ABSTRACT

BACKGROUND:

Rheumatoid arthritis(RA) is a systemic disease mainly characterized by chronic and symmetric polyarthritis. Peripheral neuropathy due to RA, however, is uncommon.

OBJECTIVE:

To analyze the clinical manifestations and laboratory findings of RA complicated by peripheral neuropathy in 5 cases.

DESIGN:

A retrospective case analysis based on patients as subjects.

SETTING:

Department of Rheumatism and Immunity, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College.

PARTICIPANTS:

Totally 567 RA patients were admitted to Peking Union Medical College Hospital from January 1983 to December 2002, including 5 cases of peripheral neuropathy. All the cases met the criteria for RA formulated by American Rheumatism Association(ARA), according to which 5 cases of peripheral neuropathy in the active phase were confirmed due to RA. The laboratory indexes in 5 cases accorded with the active core indexes of RA.

METHODS:

Clinical data of 5 cases of RA were analyzed, and symptoms of peripheral neuropathy, as well as the indexes recorded electrophysiologically and in laboratory were recorded and assessed MAIN OUTCOME

MEASURES:

Sex, age, course of disease, severity of muscle strength disorder and sensory disorder, electromyography(EMG),biopsy of muscle and nerve, and related laboratory indexes.

RESULTS:

Five cases were enrolled, including 2 males and 3 females, 42 to 60 years of age(meanly 52 years old), and the course of disease ranged 1 to 14 years, and 5.4 years on the average. Four cases were hospitalized for neurological manifestations, accounting for 80% (4/5), and the other one appeared to have decreased muscle strength and hypoalgesia. Asthenia and numbness of limbs and hypoalgesia of the distal of limbs occurred in 4 cases,paraesthesia in 3 cases, foot drop in 2 cases, carpoptosis in 1 case, myatrophy in 3 cases, decreased muscle strength in 5 cases, and tendon areflexia in 3 cases; joint swelling or pain during the appearance and aggravation of peripheral neuropathy in 4 cases, increased erythrocyte sedimentation, increased level of C-reactive protein, high-titer rheumatoid factor and X-ray changes of joints( i. e., narrowed joint space or erosion and destruction on surface of joint) in 5 cases There were 3 cases complicated by vasculitis, and 2 cases by rheumatoid nodules. EMG showed damages of peripheral nerves in 4 cases. Muscle biopsy and nerve biopsy exhibited neurogenic lesion and chronic moderate axonal neuropathy respectively in 1 case.

CONCLUSION:

In the present study, the incidence of peripheral polyneuropathy was 1% (5/569), which mainly occurred or was aggravated in the active phase of RA. Among the 5 cases of peripheral neuropathy, 100% (5/5 )developed decreased muscle strength, 60% (3/5) developed myatrophy and 80% (4/5) had symptoms of peripheral neuropathy. The findings are helpful in the early diagnosis of RA.