Ann Rehabil Med.  2014 Apr;38(2):249-255.

Assessment of Peripheral Neuropathy in Patients With Rheumatoid Arthritis Who Complain of Neurologic Symptoms

Affiliations
  • 1Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kysmart@amc.seoul.kr
  • 2Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
To assess the prevalence of peripheral neuropathy in patients with rheumatoid arthritis (RA) having neuropathic symptoms, and to investigate the relationship between electrophysiological findings of peripheral neuropathy and clinical findings of RA.
METHODS
Patients with a clinical diagnosis of RA and who had tingling or burning sensation in any extremity were electrophysiologically examined for evidence of peripheral neuropathy. Study parameters, including age, gender, laboratory parameters, duration of RA, and medication, were recorded. The symptoms and signs of neuropathy were quantified with the neuropathy symptom score, and the functional statuses of these patients were assessed.
RESULTS
Out of a total of 30 RA patients, 10 (33%) had peripheral neuropathy: 2 had bilateral carpal tunnel syndrome (CTS), 5 had unilateral CTS, 1 had sensory polyneuropathy, and 2 had motor-sensory polyneuropathy. The mean ages of the patients with and without peripheral neuropathy were 69.4 and 56.5 years, respectively (p<0.05). A significant relationship was found between peripheral neuropathy and anti-cyclic citrullinated peptide (anti-CCP) antibody. However, no relationship was found between peripheral neuropathy and the type of medication, RA duration, the patients' functional status, neuropathic symptoms, erythrocyte sedimentation rate, and C-reactive protein values.
CONCLUSION
Neuropathic symptoms are common in RA patients, and it is difficult to distinguish peripheral neuropathy symptoms from those of arthritis. Patients with RA, particularly elderly patients and anti-CCP antibody positive patients who complain of neuropathic symptoms should undergo electrophysiological examination.

Keyword

Rheumatoid arthritis; Peripheral neuropathy; Anti-cyclic citrullinated peptide

MeSH Terms

Aged
Arthritis
Arthritis, Rheumatoid*
Blood Sedimentation
Burns
C-Reactive Protein
Carpal Tunnel Syndrome
Diagnosis
Extremities
Humans
Neurologic Manifestations*
Peripheral Nervous System Diseases*
Polyneuropathies
Prevalence
Sensation
C-Reactive Protein

Reference

1. Sakini RA, Abdul-Zehra IK, Al-Nimer MS. Neuropathic manifestations in rheumatoid arthritis: a clinical and electrophysiological assessment in a small sample of Iraqi patients. Ann Saudi Med. 2005; 25:247–249. PMID: 16119528.
Article
2. Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002; 29:62–67. PMID: 11824973.
3. Johnson RL, Smyth CJ, Holt GW, Lubchenco A, Valentine E. Steroid therapy and vascular lesions in rheumatoid arthritis. Arthritis Rheum. 1959; 2:224–229. PMID: 13662216.
Article
4. Good AE, Christopher RP, Koepke GH, Bender LF, Tarter ME. Peripheral neuropathy associated with rheumatoid arthritis: a clinical and electrodiagnostic study of 70 consecutive rheumatoid arthritis patients. Ann Intern Med. 1965; 63:87–99. PMID: 14305971.
5. Nadkar MY, Agarwal R, Samant RS, Chhugani SJ, Idgunji SS, Iyer S, et al. Neuropathy in rheumatoid arthritis. J Assoc Physicians India. 2001; 49:217–220. PMID: 11225133.
6. Agarwal V, Singh R, Wiclaf , Chauhan S, Tahlan A, Ahuja CK, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008; 27:841–844. PMID: 18084807.
Article
7. Golding DN. Rheumatoid neuropathy. Br Med J. 1971; 2:169. PMID: 4103337.
Article
8. Pouget J. Vascular neuropathies. Rev Prat. 2000; 50:749–752. PMID: 10853555.
9. Salih AM, Nixon NB, Gagan RM, Heath P, Hawkins CP, Dawes PT, et al. Anti-ganglioside antibodies in patients with rheumatoid arthritis complicated by peripheral neuropathy. Br J Rheumatol. 1996; 35:725–731. PMID: 8761183.
Article
10. El M, Ashour S, Moustafa H, Ahmed I. Altered levels of soluble adhesion molecules in patients with rheumatoid arthritis complicated by peripheral neuropathy. J Rheumatol. 2002; 29:57–61. PMID: 11824972.
11. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31:315–324. PMID: 3358796.
Article
12. Dyck PJ, Sherman WR, Hallcher LM, Service FJ, O'Brien PC, Grina LA, et al. Human diabetic endoneurial sorbitol, fructose, and myo-inositol related to sural nerve morphometry. Ann Neurol. 1980; 8:590–596. PMID: 7212646.
13. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62:2569–2581. PMID: 20872595.
Article
14. Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998; 41:1196–1202. PMID: 9663475.
Article
15. Fleming A, Dodman S, Crown JM, Corbett M. Extra-articular features in early rheumatoid disease. Br Med J. 1976; 1:1241–1243. PMID: 1083759.
Article
16. Bayrak AO, Durmus D, Durmaz Y, Demir I, Canturk F, Onar MK. Electrophysiological assessment of polyneuropathic involvement in rheumatoid arthritis: relationships among demographic, clinical and laboratory findings. Neurol Res. 2010; 32:711–714. PMID: 20307377.
Article
17. Beghi E, Monticelli ML. Italian General Practitioner Study Group (IGPST). Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation of risk factors for polyneuropathy in two Italian communities. J Clin Epidemiol. 1998; 51:697–702. PMID: 9743318.
18. Weller RO, Bruckner FE, Chamberlain MA. Rheumatoid neuropathy: a histological and electrophysiological study. J Neurol Neurosurg Psychiatry. 1970; 33:592–604. PMID: 4320255.
Article
19. Mold JW, Vesely SK, Keyl BA, Schenk JB, Roberts M. The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients. J Am Board Fam Pract. 2004; 17:309–318. PMID: 15355943.
Article
20. Kroot EJ, de Jong BA, van Leeuwen MA, Swinkels H, van den Hoogen FH, van't Hof M, et al. The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis. Arthritis Rheum. 2000; 43:1831–1835. PMID: 10943873.
Article
21. van Gaalen FA, van Aken J, Huizinga TW, Schreuder GM, Breedveld FC, Zanelli E, et al. Association between HLA class II genes and autoantibodies to cyclic citrullinated peptides (CCPs) influences the severity of rheumatoid arthritis. Arthritis Rheum. 2004; 50:2113–2121. PMID: 15248208.
Article
22. Ceccato F, Roverano S, Barrionuevo A, Rillo O, Paira S. The role of anticyclic citrullinated peptide antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Clin Rheumatol. 2006; 25:854–857. PMID: 16514472.
Article
23. Turesson C, Jacobsson LT, Sturfelt G, Matteson EL, Mathsson L, Ronnelid J. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis. Ann Rheum Dis. 2007; 66:59–64. PMID: 16901955.
Article
24. Kim SK, Park SH, Shin IH, Choe JY. Anti-cyclic citrullinated peptide antibody, smoking, alcohol consumption, and disease duration as risk factors for extraarticular manifestations in Korean patients with rheumatoid arthritis. J Rheumatol. 2008; 35:995–1001. PMID: 18464311.
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr