subject: Prevalence Of Peripheral Neuropathy In Patients With Newly Diagnosed Rheumatoid Arthritis [print this page] INTRODUCTION INTRODUCTION
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized primarily by an erosive symmetric polyarthritis. It is estimated that 1% of the population suffers from this disease. Apart from involving the synovium in diarthroidal joints, RA can also involve virtually any system in the body, ranging from the lungs to the brain. These extra-articular features representing the systemic nature of the disease are seen in 1020% of patients with RA. The non-neurological extra-articular manifestations comprise rheumatoid nodules, sicca symptoms, pulmonary manifestations (interstitial lung disease, pulmonary nodules, etc.), pericarditis, vasculitis and Feltys syndrome. 1 The neurological manifestations in RA include peripheral neuropathy, cervical myelopathy due to atlantoaxial subluxation, entrapment neuropathy, and cerebral vasculitis.
Abstract
Objective
To look for the frequency and pattern of neuropathy in Indian patients with rheumatoid arthritis (RA).
Patients and Methods
One hundred newly diagnosed patients with RA (ACR 1987 revised criteria) visiting our hospital, over a period of 3 years were screened. Diabetics, outstation patients, chronic alcoholics, those with any known cause for peripheral neuropathy and patients having an overlap with the other rheumatological illness were excluded. Clinical assessment included detailed history and examination with special reference to extra-articular features and neuropathy with relevant clinical parameters like tender joint count, swollen joint count, etc. Routine laboratory investigations and autoantibodies (RF, ANA, anti-CCP) were obtained on all patients. All the patients with or without clinical manifestations of neuropathy underwent nerve conduction studies. Autonomic function studies were performed in selected patients.
Results
Subjects included 66 patients (M 13:F 53) with mean age of 42 (13.42) years and median disease duration of 36 months (IQR-13.5, 60). Sensory symptoms were present in 9 patients (13.6%). None had motor symptoms. On neurological examination, 16 patients had sensory (24.2%) and 6 (9.09%) had motor abnormalities. Nerve conduction studies showed abnormality in 25 patients (37.87%). Evidence of entrapment neuropathy was found in 6 patients (9.09%; 5 patients with median nerve involvement [unilateral, 3 and bilateral, 2] and 1 patient with unilateral ulnar nerve involvement), 3 patients had only sensory neuropathy, 5 had mixed sensory motor and 3 had only motor neuropathy. Eight patients (12.12%) had only small fibre neuropathy as detected by sympathetic skin response and quantitative sensory testing.
Conclusion
This study shows high prevalence of subclinical neuropathy in Indian patients with RA. This may be an important contributor to disability.
