Rheumatoid Meningitis

Clinical Characteristics, Diagnostic Evaluation, and Treatment

Angela M. Parsons, Fawad Aslam, Marie F. Grill, Allen Jr. Aksamit, Brent P. Goodman

Research output: Contribution to journalArticle

Abstract

Background and Purpose: Due to the potential for high mortality and neurologic complications of rheumatoid meningitis (RM), awaiting biopsy confirmation may delay vital treatment intervention. Our aim was to describe the clinical presentations of RM in our population and determine whether meningeal biopsy impacted diagnosis, treatment, and outcomes. Methods: A retrospective chart review was completed for patients at Mayo Clinic with a diagnosis of RM within the last 28 years. Those with identified alternative inflammatory, infectious, or neoplastic causes of pachymeningitis or leptomeningitis were excluded. Results: Fourteen patients meeting inclusion/exclusion criteria were identified. All patients were positive for rheumatoid factor or cyclic citrullinated peptide. All patients had magnetic resonance imaging abnormalities characterized by pachymeningeal and/or leptomeningeal enhancement. Of the 10 patients who underwent biopsy, nonspecific findings were seen in 74%. All patients except one were treated with corticosteroids with subsequent symptomatic improvement. Radiographic improvement or resolution was seen in 10 (83%) of 12. Patients improved with corticosteroid treatment, including those who were diagnosed with RM on clinical basis without undergoing a biopsy as well. Conclusions: This retrospective review displays the myriad of clinical presentations of RM. It also suggests that with appropriate exclusion of infectious, neoplastic, and other autoimmune etiologies, biopsy may not be necessary to initiate treatment.

Original languageEnglish (US)
JournalNeurohospitalist
DOIs
StatePublished - Jan 1 2019

Fingerprint

Meningitis
Biopsy
Therapeutics
Adrenal Cortex Hormones
Rheumatoid Factor
Nervous System
Magnetic Resonance Imaging
Mortality
Population

Keywords

  • biopsy
  • rheumatoid arthritis
  • rheumatoid meningitis
  • rheumatoid pachymeningitis

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Rheumatoid Meningitis : Clinical Characteristics, Diagnostic Evaluation, and Treatment. / Parsons, Angela M.; Aslam, Fawad; Grill, Marie F.; Aksamit, Allen Jr.; Goodman, Brent P.

In: Neurohospitalist, 01.01.2019.

Research output: Contribution to journalArticle

Parsons, Angela M. ; Aslam, Fawad ; Grill, Marie F. ; Aksamit, Allen Jr. ; Goodman, Brent P. / Rheumatoid Meningitis : Clinical Characteristics, Diagnostic Evaluation, and Treatment. In: Neurohospitalist. 2019.
@article{4387a341dab644d380c9a5eea77935b4,
title = "Rheumatoid Meningitis: Clinical Characteristics, Diagnostic Evaluation, and Treatment",
abstract = "Background and Purpose: Due to the potential for high mortality and neurologic complications of rheumatoid meningitis (RM), awaiting biopsy confirmation may delay vital treatment intervention. Our aim was to describe the clinical presentations of RM in our population and determine whether meningeal biopsy impacted diagnosis, treatment, and outcomes. Methods: A retrospective chart review was completed for patients at Mayo Clinic with a diagnosis of RM within the last 28 years. Those with identified alternative inflammatory, infectious, or neoplastic causes of pachymeningitis or leptomeningitis were excluded. Results: Fourteen patients meeting inclusion/exclusion criteria were identified. All patients were positive for rheumatoid factor or cyclic citrullinated peptide. All patients had magnetic resonance imaging abnormalities characterized by pachymeningeal and/or leptomeningeal enhancement. Of the 10 patients who underwent biopsy, nonspecific findings were seen in 74{\%}. All patients except one were treated with corticosteroids with subsequent symptomatic improvement. Radiographic improvement or resolution was seen in 10 (83{\%}) of 12. Patients improved with corticosteroid treatment, including those who were diagnosed with RM on clinical basis without undergoing a biopsy as well. Conclusions: This retrospective review displays the myriad of clinical presentations of RM. It also suggests that with appropriate exclusion of infectious, neoplastic, and other autoimmune etiologies, biopsy may not be necessary to initiate treatment.",
keywords = "biopsy, rheumatoid arthritis, rheumatoid meningitis, rheumatoid pachymeningitis",
author = "Parsons, {Angela M.} and Fawad Aslam and Grill, {Marie F.} and Aksamit, {Allen Jr.} and Goodman, {Brent P.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/1941874419859769",
language = "English (US)",
journal = "The Neurohospitalist",
issn = "1941-8744",
publisher = "Sage Publications",

}

TY - JOUR

T1 - Rheumatoid Meningitis

T2 - Clinical Characteristics, Diagnostic Evaluation, and Treatment

AU - Parsons, Angela M.

AU - Aslam, Fawad

AU - Grill, Marie F.

AU - Aksamit, Allen Jr.

AU - Goodman, Brent P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Purpose: Due to the potential for high mortality and neurologic complications of rheumatoid meningitis (RM), awaiting biopsy confirmation may delay vital treatment intervention. Our aim was to describe the clinical presentations of RM in our population and determine whether meningeal biopsy impacted diagnosis, treatment, and outcomes. Methods: A retrospective chart review was completed for patients at Mayo Clinic with a diagnosis of RM within the last 28 years. Those with identified alternative inflammatory, infectious, or neoplastic causes of pachymeningitis or leptomeningitis were excluded. Results: Fourteen patients meeting inclusion/exclusion criteria were identified. All patients were positive for rheumatoid factor or cyclic citrullinated peptide. All patients had magnetic resonance imaging abnormalities characterized by pachymeningeal and/or leptomeningeal enhancement. Of the 10 patients who underwent biopsy, nonspecific findings were seen in 74%. All patients except one were treated with corticosteroids with subsequent symptomatic improvement. Radiographic improvement or resolution was seen in 10 (83%) of 12. Patients improved with corticosteroid treatment, including those who were diagnosed with RM on clinical basis without undergoing a biopsy as well. Conclusions: This retrospective review displays the myriad of clinical presentations of RM. It also suggests that with appropriate exclusion of infectious, neoplastic, and other autoimmune etiologies, biopsy may not be necessary to initiate treatment.

AB - Background and Purpose: Due to the potential for high mortality and neurologic complications of rheumatoid meningitis (RM), awaiting biopsy confirmation may delay vital treatment intervention. Our aim was to describe the clinical presentations of RM in our population and determine whether meningeal biopsy impacted diagnosis, treatment, and outcomes. Methods: A retrospective chart review was completed for patients at Mayo Clinic with a diagnosis of RM within the last 28 years. Those with identified alternative inflammatory, infectious, or neoplastic causes of pachymeningitis or leptomeningitis were excluded. Results: Fourteen patients meeting inclusion/exclusion criteria were identified. All patients were positive for rheumatoid factor or cyclic citrullinated peptide. All patients had magnetic resonance imaging abnormalities characterized by pachymeningeal and/or leptomeningeal enhancement. Of the 10 patients who underwent biopsy, nonspecific findings were seen in 74%. All patients except one were treated with corticosteroids with subsequent symptomatic improvement. Radiographic improvement or resolution was seen in 10 (83%) of 12. Patients improved with corticosteroid treatment, including those who were diagnosed with RM on clinical basis without undergoing a biopsy as well. Conclusions: This retrospective review displays the myriad of clinical presentations of RM. It also suggests that with appropriate exclusion of infectious, neoplastic, and other autoimmune etiologies, biopsy may not be necessary to initiate treatment.

KW - biopsy

KW - rheumatoid arthritis

KW - rheumatoid meningitis

KW - rheumatoid pachymeningitis

UR - http://www.scopus.com/inward/record.url?scp=85068604313&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068604313&partnerID=8YFLogxK

U2 - 10.1177/1941874419859769

DO - 10.1177/1941874419859769

M3 - Article

JO - The Neurohospitalist

JF - The Neurohospitalist

SN - 1941-8744

ER -