Chouk Mickaël, Halb Alexandre, Mekhail Christine, Godot Amélie, Verhoeven Frank, Prati Clément, Wendling Daniel
Service de Rhumatologie, CHRU Besançon, Besançon, France.
Service de Neurologie, CHRU Besançon, Besançon, France.
Eur J Case Rep Intern Med. 2021 Apr 21;8(4):002358. doi: 10.12890/2021_002358. eCollection 2021.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized mainly by arthritis, with the possible occurrence of extra-articular manifestations. We report the case of a patient who developed leptomeningitis as the first sign of RA, one year before the diagnosis of RA. Methylprednisolone 1000 mg was given intravenously. Because of the onset of seizures and cognitive impairment, rituximab was started. After three cycles of rituximab (1000 mg on day 0 and 1000 mg on day 15, every 6 months), neurological clinical examination, MRI and electroencephalogram findings were significantly improved.
Rheumatoid meningitis may occur in the disease course of rheumatoid arthritis with varied and non-specific symptoms.Cerebrospinal fluid examination, MRI and tests for rheumatoid factor or anti-citrullinated protein antibodies in serum or in cerebrospinal fluid are key examinations for diagnosing rheumatoid meningitis.Rituximab has good efficacy in rheumatoid meningitis.
类风湿关节炎（RA）是一种主要以关节炎为特征的慢性炎症性疾病，可能出现关节外表现。我们报告一例患者，在类风湿关节炎诊断前一年，出现柔脑膜炎症作为类风湿关节炎的首发症状。静脉注射1000毫克甲泼尼龙。由于癫痫发作和认知障碍的出现，开始使用利妥昔单抗。在三个周期的利妥昔单抗治疗（第0天1000毫克，第15天1000毫克，每6个月一次）后，神经科临床检查、MRI和脑电图结果有显著改善。
类风湿性脑膜炎可能发生在类风湿关节炎的病程中，症状多样且不具特异性。脑脊液检查、MRI以及血清或脑脊液中类风湿因子或抗瓜氨酸化蛋白抗体检测是诊断类风湿性脑膜炎的关键检查。利妥昔单抗在类风湿性脑膜炎中有良好疗效。
