Peripheral Neuropathy in Rheumatoid Arthritis

Abstract

Thirty patients with rheumatoid arthritis and peripheral neuropathy have been personally studied and five patterns of neurological involvement defined: (I) upper limbs: lesions of major peripheral nerves; (II) upper limbs: “ digital neuropathy ”; (III) lower limbs: lesions of major peripheral nerves; (IV) lower limbs: “ distal sensory neuropathy ”; and (V) distal sensori-motor polyneuropathy of upper and lower limbs. In the first four groups the tendency of the neurological lesion was towards recovery, and the prognosis regarding life was usually good. The patients with distal sensorimotor polyneuropathy, however, all died with widespread vasculitis. In most patients the neuropathy was thought to be due to occlusion of the vasa nervorum by the arterial disease sometimes associated with rheumatoid arthritis. This view was supported in our cases by clinical and histological evidence and by the finding, on brachial arteriography, of occlusive lesions in the digital vessels in the majority of instances. In a few patients the neuropathy was attributed to local pressure from a damaged or swollen joint. In others both pressure and vascular disease were thought to operate. It is confirmed that patients with rheumatoid arthritis and ischaemic neuropathy have a positive differential agglutination titre and a high incidence of nodule formation. They often show evidence of vasculitis elsewhere. This is not necessarily so where pressure alone is the cause of the neuropathy. Many of the patients were receiving steroids, but no clear evidence emerged that this therapy was directly related to the development of neuropathy. © 1965, British Medical Journal Publishing Group. All rights reserved.