Das Shyamashis, Sinha Debanjali, Ghosal Anirban, Purkayastha Sukalyan
Department of Rheumatology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India.
Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India.
Mod Rheumatol Case Rep. 2023 Jan 3;7(1):130-133. doi: 10.1093/mrcr/rxac042.
Here, we report a case of central nervous system vasculitis in rheumatoid arthritis (RA) treated successfully with corticosteroid and mycophenolate. A 53-year-old female with poorly controlled RA presented with unilateral lower motor neurone type seventh cranial nerve palsy. Magnetic resonance imaging (MRI) of the brain revealed bilateral signal intensity changes in posterior fossa, basal ganglia, and periventricular white matter with contrast enhancement. Rheumatoid factor, anti-cyclic citrullinated peptides, and C-reactive protein were high. Cerebrospinal fluid analysis showed pleocytosis with elevated protein. Digital subtraction angiography of the brain revealed a beading pattern in distal branches of anterior, middle, and posterior cerebral arteries bilaterally suggestive of central nervous system vasculitis. We treated the patient with intravenous methylprednisolone followed by oral prednisolone tapered off in 6 months. Mycophenolate mofetil was started at the dose of 2 g per day, along with prednisolone. Sulfasalazine and hydroxychloroquine were also started to treat her arthritis. The patient showed complete neurological improvement, along with a significant resolution of the lesions in MRI.
在此，我们报告一例类风湿关节炎（RA）合并中枢神经系统血管炎的病例，该病例通过皮质类固醇和霉酚酸酯治疗成功。一名53岁女性，类风湿关节炎控制不佳，出现单侧下运动神经元型第七颅神经麻痹。脑部磁共振成像（MRI）显示后颅窝、基底节和脑室周围白质有双侧信号强度改变，并伴有强化。类风湿因子、抗环瓜氨酸肽和C反应蛋白水平升高。脑脊液分析显示细胞增多且蛋白升高。脑部数字减影血管造影显示双侧大脑前、中、后动脉远端分支呈串珠样改变，提示中枢神经系统血管炎。我们先用静脉注射甲泼尼龙治疗该患者，随后口服泼尼松龙，并在6个月内逐渐减量。霉酚酸酯以每日2克的剂量开始使用，同时服用泼尼松龙。还开始使用柳氮磺胺吡啶和羟氯喹治疗她的关节炎。患者神经功能完全改善，MRI上的病变也显著消退。
