Rheumatoid meningitis sine arthritis: An emerging cause of isolated pachymeningitis and leptomeningitis with typical features

Brain disorders (Amsterdam, Netherlands) Pub Date : 2024-07-26 DOI:10.1016/j.dscb.2024.100156

Mickael Bonnan , Matthieu Faillot , Adrien Carle , Nicolas Defoor , Juliette Rocca , Gédéon Balley , Franck Bielle , Dominique Cazals-Hatem , Fahima Fernani , Carole Henry

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Abstract

Background and purpose

Rheumatoid meningitis (RM) is a meningeal inflammation rarely occurring during the course of rheumatoid arthritis (RA). Anti-citrullinated protein antibodies (ACPA), which are highly specific biomarkers of RA, may allow RM sine arthritis (RMSA) to be diagnosed as an extra-articular early lesion of RA. MRI typically displays pachymeningitis and/or leptomeningitis predating convexity, and CSF diffusivity is focally restricted. Blood ACPA is a strong clue and intrathecal synthesis of ACPA is characteristic although rarely reported.

Methods

We report two cases of RMSA that were confirmed by meningeal biopsy and intrathecal synthesis.

Results

RMSA abated after steroids alone or associated with rituximab. No arthritis occurred during the follow-up.

Conclusion

RM can occur in the absence of RA.

Abstract Image

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无关节炎的类风湿性脑膜炎：具有典型特征的孤立性桥脑膜炎和脑 Leptomeningitis 的新病因

背景和目的类风湿脑膜炎（RM）是类风湿性关节炎（RA）病程中很少发生的一种脑膜炎症。抗瓜氨酸蛋白抗体（ACPA）是类风湿性关节炎的高度特异性生物标志物，可将类风湿性脑膜炎（RMSA）诊断为类风湿关节炎的关节外早期病变。磁共振成像（MRI）通常显示在凸起之前的桥脑膜炎和/或脑脊髓炎，脑脊液弥散也会受到局部限制。方法我们报告了两例经脑膜活检和鞘内合成证实的RMSA病例。结果单用类固醇激素或联合利妥昔单抗治疗后，RMSA缓解。结论RMSA可在无RA的情况下发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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