Vascular polyneuropathy in rheumatoid arthritis
Rosenberger, K.
Fortschritte der Neurologie Psychiatrie und Ihrer Grenzgebiete 45(10): 536-544
1977
ISSN/ISBN: 0015-8194 PMID: 21838 Document Number: 114600
One case of polyneuropathy in rheumatoid arthritis was described. This was followed by a survey of 41 further cases from the literature which were divided into 2 groups according to the way the polyneuropathy presented. There were 29 patients in the 1st group in whom polyneuropathy started acutely or subacutely. They all showed both sensory and motor defects and, at least at the start, were asymmetrical as in mononeuritis multiplex. In this type of polyneuropathy there was always a necrotizing arteritis of the vasa nervorum and of the adjoining skeletal muscle. In almost 1/2 of these patients arteritis became generalized with ischemic lesions of internal organs leading in most instances to death. These severe cases could not be differentiated clinically or histologically from panarteritis nodosa, but the prognosis of necrotizing rheumatoid arteritis was altogether clearly better than that of panarteritis nodosa. The 2nd group (12) in which the polyneuropathy developed gradually was always symmetrical and predominantly distal. Sensory defects predominated, motor disturbances were rare or absent. The prognosis of rheumatoid arthritis was not aggravated by this type of polyneuropathy. Histologically necrotizing arteritis was never seen; simple arteritis, as seen in rheumatoid arthritis without clinical signs of vascular involvement was noted only occasionally. This group probably did not have vascular polyneuropathy. There was no evidence for any other common cause.