Abstract
Although the clinical hallmark of rheumatoid arthritis (RA) involves inflammatory joint disease, extra-articular manifestations may be evident in 20% of patients. Among them neurologic features involving both the peripheral and central nervous system are one of the more common, but little has been noticed about it in clinic. The same mechanisms participating in joint destruction, synovial inflammation, and vasculitis contribute to the various RA neurological complications. In this article, we reviewed clinical outcomes of peripheral neuropathies of the upper extremity associated with RA and discussed the proper diagnosis and operative indication. Magnetic resonance imaging and electrophysiological examination are the best tools to lead the final diagnosis of nerve palsy secondary to RA synovial cyst. Such neuropathies require consideration in the differential diagnosis of wrist and hand disability. Surgical decompression is recommended at prompt timing if neurophysiologic studies demonstrate denervation or significant motor abnormalities, or sensory symptoms progress despite adequate medication.
Similar content being viewed by others
References
Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G (1998) Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum 41:1196–1202
Nadkar MY, Agarwal R, Samant RS, Chhugani SJ, Idgunji SS, Iyer S, Borges NE (2001) Neuropathy in rheumatoid arthritis. J Assoc Physicians India 49:217–220
Golding DN (1971) Rheumatoid neuropathy. Br Med J 17(2):169
Canesi B, Colombo S, Marobbio C, Rossi AF (1982) Latent neuropathy in rheumatoid arthritis. Electrophysiological study of 45 Cases. Minerva Med 73(9):473–478
Bekkelund SI, Torbergsen T, Husby G, Mellgren S (1999) Myopathy and neuropathy in rheumatoid arthritis. A quantitative controlled electromyographic study. J Rheumatol 26:2348–2351
Sivri A, Guler-Uysal F (1999) The electroneurophysiological findings in rheumatoid arthritis patients. Electromyogr Clin Neurophysiol 39:387–391
Sivri A, Güler-Uysal F (1998) The electroneurophysiological evaluation of rheumatoid arthritis patients. Clin Rheumatol 17(5):416–418
Agarwal V, Singh R, Wiclaf, Chauhan S, Tahlan A, Ahuja CK, Goel D, Pal L (2007) A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol 15:(Epub ahead of print)
Chamberlain MA, Bruckner FE (1970) Rheumatoid neuropathy. Clinical and electrophysiological features. Ann Rheum Dis 29:609–616
Conn DL, McDuffie FC, Dyck PJ (1972) Immunopathologic study of sural nerves in rheumatoid arthritis. Arthritis Rheum 15:135–143
Puechal X, Said G, Hilliquin P (1995) Peripheral neuropathy with necrotizing vasculitis in rheumatoid arthritis. A clinicopathologic and prognostic study of thirty-two patients. Arthritis Rheum 38:1618–1629
Nakano KK (1975) The entrapment neuropathies of rheumatoid arthritis. Orthop Clin North Am 6:837–860
Muramatsu K, Kojima T, Yoshida K (2006) Peripheral neuropathies associated with rheumatoid synovial cysts of the elbow joint: three case reports. J Clin Rheumatol 12:287–290
Uchiyama S, Itsubo T, Yasutomi T (2005) Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 76:1103–1108
Geoghegan JM, Clark DI, Bainbridge LC (2004) Risk factors in carpal tunnel syndrome. J Hand Surg 29-B:315–320
Stevens JC, Beard CM, O’Fallon WM, Kurland LT (1992) Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 67:541–548
Durkan JA (1994) The carpal-compression test. An instrumented device for diagnosing carpal tunnel syndrome. Orthop Rev 23:522–525
Shinoda J, Hashizume H, McCown C (2002) Carpal tunnel syndrome grading system in rheumatoid arthritis. J Orthop Sci 7:188–193
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324
Kelly CP, Pulisetti D, Jamieson AM (1994) Early experience with endoscopic carpal tunnel release. J Hand Surg 19-B:18–21
Belcher HJ, Varma S, Schonauer F (2000) Endoscopic carpal tunnel release in selected rheumatoid patients. J Hand Surg 25-B:451–452
Fernandes L, Goodwill CJ, Srivatsa SR (1979) Synovial rupture of rheumatoid elbow causing radial nerve compression. Br Med J 2:17–18
Ishikawa H, Hirohata K (1990) Posterior interosseous nerve syndrome associated with rheumatoid synovial cysts of the elbow joint. Clin Orthop Relat Res 254:134–139
Westkaemper JG, Varitimidis SE, Sotereanos DG (1999) Posterior interosseous nerve palsy in a patient with rheumatoid synovitis of the elbow: a case report and review of the literature. J Hand Surg 24-B:727–731
Keret D, Porter KM (1984) Synovial cyst and ulnar nerve entrapment. A case report. Clin Orthop Relat Res 188:213–216
White SH, Goodfellow JW, Mowat A (1988) Posterior interosseous nerve palsy in rheumatoid arthritis. J Bone Joint Surg 70-B:468–471
Mainard D, Saury P, Delagoutte JP (1991) Ulnar nerve compression at the elbow caused by synovial cyst of rheumatoid origin. Rev Rhum Mal Osteoartic 58:611–614
Nakagawa N, Abe S, Saegusa Y (2004) Giant geode at the olecranon in the rheumatoid elbow—two case reports. Clin Rheumatol 23:358–361
Magyar E, Talerman A, Feher M, Wouters HW (1974) The pathogenesis of the subchondral pseudocysts in rheumatoid arthritis. Clin Orthop Relat Res 100:341–344
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Muramatsu, K., Tanaka, H. & Taguchi, T. Peripheral neuropathies of the forearm and hand in rheumatoid arthritis: diagnosis and options for treatment. Rheumatol Int 28, 951–957 (2008). https://doi.org/10.1007/s00296-008-0630-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-008-0630-8