Rheumatoid Arthritis Inflammation of the Brain
Rheumatoid meningitis is a serious extra-articular brain manifestation of RA.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by pain, stiffness, swelling, limited mobility, and loss of joint function. Apart from the joints, RA can affect other parts of the body including the lungs, skin, kidneys, and brain.

Rheumatoid meningitis is a rare neurological complication of long-standing RA characterized by stroke-like episodes.

Some scientists demonstrated that chronic inflammation in the body (the hallmark of RA) due to the release of cytokines such as tumor necrosis factor can change the way the brain functions, which can contribute to many disease-associated symptoms, including brain fog.

Other factors that may contribute to brain involvement in RA include:

  • Pain: Some of the pain-processing centers in the brain overlap with areas involved with memory and attention. Thus, chronic pain in RA may hamper these brain functions.
  • Depression: Common in RA due to chronic pain and disturbances in personal and work-related activities.
  • Cardiovascular disease: People with RA are prone to have narrowed or blocked arteries in the brain, the result of systemic inflammation, which can cause problems with memory, thinking, and reasoning.
  • Medications: Methotrexate, the primary treatment of RA, and corticosteroids, for short-term pain relief, may cause cognitive problems, mood changes, and confusion.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic, inflammatory disease in which the immune system mistakenly attacks the lining of the membrane that surrounds joints, particularly the smaller joints of the hand and wrist, although larger joints such as the shoulders, hips, and knees may become involved later in the disease. The autoimmune reaction also affects other organs and tissues in the body.

RA is estimated to affect up to one percent of the population worldwide.

Most joints are covered with a lining called the synovium, which lubricates the joint for easy movement.

In RA, the synovium becomes inflamed (synovitis), thickens, and produces an excess of joint fluid. This fluid along with the inflammatory chemicals released by the immune system causes swelling, damages cartilage, and softens the bone within the joint. 

The swollen tissues stretch the surrounding ligaments, resulting in deformity, instability, and weakened and damaged tendons and ligaments.

What are the signs and symptoms of brain involvement in rheumatoid arthritis?

The most common signs and symptoms of rheumatoid arthritis (RA) include:

  • Pain, swelling, and stiffness of the joints
  • Joints are typically affected in a symmetrical pattern (both hands and feet are affected simultaneously)
  • Joint pain and stiffness are worse in the morning or after a long period of rest

Rheumatoid meningitis is a serious extra-articular brain manifestation of RA.

Symptoms of brain involvement in RA may include:

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

How is rheumatoid meningitis diagnosed?

The diagnosis of rheumatoid meningitis (RM) is challenging due to misleading presentation with stroke-like episodes or the absence of other clinical features that suggest rheumatoid arthritis (RA).

In most cases, the diagnosis of RM preceded the diagnosis of RA within the first three months of initial presentation or was diagnosed simultaneously.

  • MRI: Often shows changes in the meninges (leptomeningeal and pachymeningeal enhancement) but can involve the brain parenchyma.
  • Cerebrospinal fluid analysis: Typically shows lymphocytic pleocytosis (an abnormal increase in lymphocyte count in the cerebrospinal fluid).
  • Meningeal biopsy: Positive findings involve necrotizing granulomas consistent with RM.
  • Rheumatoid factor and anticyclic citrullinated peptide antibodies: Both are characteristically elevated in RA.

What other conditions can resemble rheumatoid meningitis?

Other conditions that resemble rheumatoid meningitis include:

How is rheumatoid meningitis treated?

Unfortunately, there are no clear guidelines for the treatment of rheumatoid meningitis. Treatment usually involves high-dose corticosteroids or immunomodulatory therapy, or both.

What are the other complications of rheumatoid arthritis?

In severe cases, affected individuals may develop abnormal inflammation that leads to severe joint damage, which limits movement and can cause significant disability.

A few other complications include:

  • Rheumatoid nodules (tiny firm bumps that develop around the pressure areas such as the elbows and finger joints)
  • Dry eyes and mouth (a disorder characterized by a decrease in the amount of moisture in the eyes and mouth)
  • Carpal tunnel syndrome (compression of the median nerve leading to numbness and tingling pain in the hand and forearm)
  • Osteoporosis
  • Heart problems
  • Lung disease
  • Lymphoma (cancer in the lymph system)

SLIDESHOW

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow

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Medically Reviewed on 10/21/2022
References
Image Source: iStock image

Rheumatoid meningitis NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276349/#:~:text=Rheumatoid%20meningitis%20(RM)%20is%20a%20rare%20and%20diagnostically%20challenging%20manifestation,headache%2C%20and%20altered%20mental%20status.

RA's Effect on the Brain Arthritis Foundation: https://www.arthritis.org/diseases/more-about/ra-effect-on-the-brain

Successful treatment of rheumatoid meningitis with cyclophosphamide but not infliximab NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798234/

Rheumatoid meningitis Frontiers: https://www.frontiersin.org/articles/10.3389/fneur.2011.00084/full