Number№82 (4) 2020

CLINICAL CASES OF LIVING DIAGNOSIS OF RHEUMATOID MENINGITIS WITH HISTOLOGICAL VERIFICATION

Golovach I.Yu.1, Yehudina Ye.D.2

Summary. Rheumatoid arthritis (RA) is a chro­nic disease, the etiology of which has yet to be clari­fied, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. If abnormalities of the peripheral nervous system are observed fairly widely in RA, the central nervous system (CNS) lesion is uncommon in such patients. The involvement of the central nervous system, as a rule, develops in patients who had a long-term history of RA, irrespective of the disease activity of systemic arthritis, and it has a high mortality rate despite treatment. Since clinical symptoms and radiologic signs are rather nonspecific, in short of doing biopsy, the diagnosis of rheumatoid meningitis (RM) is one of exclusion. However, the strongly positive rheumatoid factor in the cerebrospinal fluid is quite specific. Two cli­nical observations of RM with a rather different clinical symptom are presented. Described differential diagnosis of central nervous system involvement in RA with the main diagnostic procedures, an asses­sment of the effectiveness of treatment in both ca­ses. Physicians should be very careful in the pre­sence of encephalopathy symptoms, headache, seizures or focal neurological deficits in RA patients should raise suspicion for CNS involvement with the prescription of appropriate investigations, because this potential complication requires rapid diagnosis and specific treatment. This potentially treatable disease warrants prompt diagnosis and specific treatment.

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