Obaed Nadia G, Elsheshtawi Mohamed, Jones Can, Kothari Vivek, Estica Tabitha, Menchaca Kristina, Isaac Shaun
Allopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Internal Medicine, University of Miami, John F. Kennedy (JFK) Medical Center, Atlantis, USA.
Cureus. 2023 Jan 12;15(1):e33693. doi: 10.7759/cureus.33693. eCollection 2023 Jan.
Rheumatoid arthritis is a chronic inflammatory condition with many manifestations primarily presenting in older female patients with joint stiffness. Quadriplegia associated with rheumatoid arthritis is common and can occur secondary to spinal cord compression from atlantoaxial dislocation. In contrast, functional quadriplegia is rare and has not been previously reported as an initial manifestation of rheumatoid arthritis. We report the case of a 56-year-old male with a past medical history of carotid artery stenosis, hypertension, and tobacco and alcohol misuse who presented to the emergency department with a five-month history of progressive bilateral shoulder pain and weakness resulting in functional quadriplegia. The patient required inpatient hospital admission for further evaluation of his functional quadriplegia and associated symptoms. His workup was significant for rheumatoid arthritis, and he was successfully treated with high-dose steroids and received physical and occupational therapy during admission. Prior to discharge, the patient was initiated on methotrexate therapy and appointed a follow-up with primary care and rheumatology. The purpose of this study is to facilitate early clinical recognition of a common disease with unique and underreported symptomatology.
类风湿性关节炎是一种慢性炎症性疾病，有多种表现，主要见于老年女性患者，伴有关节僵硬。类风湿性关节炎相关的四肢瘫痪很常见，可继发于寰枢椎脱位导致的脊髓压迫。相比之下，功能性四肢瘫痪很少见，此前尚未有作为类风湿性关节炎初始表现的报道。我们报告一例56岁男性病例，其既往有颈动脉狭窄、高血压病史，有烟酒滥用情况，因进行性双侧肩部疼痛和无力伴功能性四肢瘫痪5个月就诊于急诊科。该患者需要住院进一步评估其功能性四肢瘫痪及相关症状。他的检查结果显示患有类风湿性关节炎，通过大剂量类固醇成功治疗，住院期间接受了物理和职业治疗。出院前，患者开始接受甲氨蝶呤治疗，并预约了初级保健和风湿病科的随访。本研究的目的是促进对一种具有独特且报道不足症状的常见疾病的早期临床识别。
