Title: Peripheral Neuropathy In Rheumatoid Arthritis: A Hospital Based Study
Authors: Kumar Rajesh, Pradhan RN, Bhagatula S
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.16
Extra articular manifestations of rheumatoid arthritis are seen in 10-20% of individuals representing the systemic nature of the disease.20-30%of these, suffer with neuropathic manifestations .It contributes significantly to the disability caused by the disease warranting to pick up those sub clinical cases of neuropathy and to treat them early. Paucity of literature on rheumatoid neuropathy creates a lacuna in critical evaluation and discussion of this subject.. Aim of The Study: It was to find incidence of peripheral neuropathy and their patterns in patients of rheumatoid arthritis and its correlation with severity of the disease and markers of inflammation Materials And Methods: A cross sectional randomised observational study was conducted in patients diagnosed of rheumatoid arthritis (based on EULAR, ACR2010 criteria) between May 2011-2013 were questioned pertaining to symptoms of neuropathy with special attention to distal symmetric sensory involvement. All individuals were subjected to complete electrophysiological nerve conduction study. Disease severity was assessed with DAS28 scoring system and were tested for inflammatory markers (ESR, CRP, Anti CCP antibodies). Results: A total of 50 cases of rheumatoid arthritis were analysed and incidence of neuropathy was found in 60%(30/50) with predominantly pure sensory neuropathy 50%(15/30,) sensory motor neuropathy 30% (9/30), mono neuritis multiplex10%(3/30) and carpal tunnel syndrome 10%(3/30). Incidence was found to be more in female sex as is the disease itself and is associated with a DAS 28 score of >5.1 in 96.67%,a positive CRP in 86.6%, ESR of 30-60 mm/hr in 60% and a strongly positive anti-CCP>60 IU in 66.6% individuals. Conclusion: Peripheral neuropathy in rheumatoid arthritis is relatively a common manifestation with female preponderance and fifty percent of patients having sub clinical neuropathy. Majority have pure sensory type with a mean duration of 55.04 months of illness, severe form of disease and positive inflammatory markers. Key Words: DAS 28, Extra- Articular manifestation, Peripheral Neuropathy, Rheumatoid Arthritis 1. O’Dell JR : Rheumatic disease. In Goldman L, Ansiello D, editors : Cecilmedicine -23 :2007 2. Lipsky PE : Rheumatoid arthritis. In Fauci AS, Kasper DL, Longo DL, editors:Harrisons Principles of Internal Medicine, ed. 17: 2008 3. QJM : An International Journal Of Medicine;Vol.99, Issue 2, ): 69- 79. 4. Kar M, Mukherjee S, Mandal D, et al. Neuropathy in rheumatoid arthritis: clinicaland electrophysiological observations. Bull Indian Rheumatism Assoc 1991; 5: 80–2. 5. Nadkar MY, Agarwal R, Samant RS, Chhugani SJ, Idgunji SS, Iyer S, et al. Neuropathy in rheumatoid arthritis. J Assoc Physicians India.2001;49:217–20. 6. Sivri A, Güler-Uysal F. The electroneurophysiological findings in rheumatoidarthritis patients. Electromyogr Clin Neurophysiol. 1999 Oct-Dec; 39(7) :387-91. 7. Singh H, Handa R , Sood S, Kumar H, Goyal M, Kumar S. To study the frequency of subclinical neuropathy in RA and its relation to duration of disease. JAPI.org,December 2009, 57. (special issue). 8. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum.2010;62:2569–81. 9. Malaviya AN, Singh RR, Kapoor SK, Sharma A, Kumar A, Singh YN. Prevalence of rheumatic diseases in India: results of a population study. J Ind RhellmaJismAssoc 1994; 2: 13-7. 10. Agarwal V, Singh R, Wiclaf, Chauhan S, Tahlan A, Ahuja CK, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008;27:841–44. 11. Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998;41:1196–02. 12. Biswas M, Chatterjee A, Ghosh SK et al. Prevalence, types, clinical associations and determinants of peripheral neuropathy in rheumatoid patients. Ann Indian Acad Neurol 2011;14:194-7 13. Aneja R, Singh MB, Shankar S, Dhir V, Grover R, Gupta R, et al.Prevalence of peripheral neuropathy in patients with newly detectedrheumatoid arthritis. Indian J Rheumatol 2007 ; 2 : 47-50 14. Dani K, Ramachandran R, Capell HA, Madhok R et al. Neuropathies in therheumatoid patients : A case of the heavy hand. Scott Med J 2005, 50 : 125-6 15. Bayrak AO, Durmus D, Durmaz Y et al. Electrophysiological assessment of polyneuropathic involvement in rheumatoid arthritis: relationships among demographic, clinical and laboratory findings. Neurol Res 2010; 32:711-14 16. Sim MK, Kim D-Y, Yoon J, Park DH, Kim Y-G. Assessment of Peripheral Neuropathy in Patients With Rheumatoid Arthritis Who Complain of Neurologic Symptoms. Annals of Rehabilitation Medicine. 2014;38(2):249-55. Abstract
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