Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University; Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Neurol India. 2020 Mar-Apr;68(2):481-482. doi: 10.4103/0028-3886.284382.
In order to make a correct diagnosis of idiopathic Parkinson's disease (PD), it is essential to exclude atypical parkinsonian features, such as early dementia, fall, and autonomic dysfunction. Rheumatoid arthritis (RA), which is a systemic inflammatory disorder, although most patients present in a polyarticular manner. Still some may also present with extra-articular involvement including skin, lung, heart, and the central or peripheral nervous systems. A possible pathogenetic link between RA and PD are proposed. However, the coexistence of RA and progressive supranuclear palsy (PSP) is rarely reported. Here, we report a parkinsonian patient with a newly diagnosed flare-up RA presenting with early falls, postural instability and supra-nuclear gaze palsy, which suggestive of clinically probable PSP. Furthermore, the parkinsonian features respond to anti-rheumatic agents, but not levodopa. Finally, the patient looks like a clinical possible PD. In summary, Parkinsonian patient with newly diagnosed flare-up RA can present with clinically probable PSP. Unbearably painful limb contracture is a clue of the coexistence of RA. Both typical and atypical parkinsonian features respond dramatically to anti-rheumatic medication, but not levodopa.
为了对特发性帕金森病 (PD) 做出正确诊断，必须排除不典型帕金森特征，如早期痴呆、跌倒和自主神经功能障碍。类风湿关节炎 (RA) 是一种系统性炎症性疾病，尽管大多数患者表现为多关节方式，但仍有一些患者可能存在关节外受累，包括皮肤、肺、心脏和中枢或周围神经系统。提出了 RA 和 PD 之间可能存在的发病机制联系。然而，RA 和进行性核上性麻痹 (PSP) 同时存在的情况很少见。在这里，我们报告了一例新诊断的 RA 发作期帕金森病患者，表现为早期跌倒、姿势不稳和核上性凝视麻痹，提示临床可能的 PSP。此外，帕金森病的特征对抗风湿药物有反应，但对左旋多巴没有反应。最后，患者看起来像是临床可能的 PD。总之，新诊断的 RA 发作期帕金森病患者可出现临床可能的 PSP。难以忍受的肢体挛缩是 RA 共存的线索。典型和不典型的帕金森病特征对抗风湿药物反应明显，但对左旋多巴没有反应。
