Evidence map›Paper›PMID 39009895›Full record

ReviewNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2024

Rheumatoid meningitis: a case series report and review of modern therapeutic schemes and outcome.

Carlos Serra Smith, Fernando José Montero Reyes, Ana Contreras Chicote, Julia Martínez Barrio, Mihaela Vieru, Isabel Herrera Herrera, Francisco Arias, Marisa Martínez Ginés, Jose Manuel García Domínguez

Abstract readCase ReportsReview
PubMed Publisher
In one paragraph

Review in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Carlos Serra SmithNeurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain. caserra@ucm.es.ORCID http://orcid.org/0000-0002-3948-8862
Fernando José Montero ReyesRheumatology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Ana Contreras ChicoteNeurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Julia Martínez BarrioRheumatology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Mihaela VieruAnatomical Pathology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Isabel Herrera HerreraNeurorradiology Section, Radiology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Francisco AriasAnatomical Pathology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Marisa Martínez GinésNeurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Jose Manuel García DomínguezNeurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionRheumatoid meningitis (RM) is an extremely rare extra-articular complication of rheumatoid arthritis (RA), with approximately 165 cases reported world-wide. RM exhibits a broad range of symptoms, with stroke-like episodes and seizures being the most common manifestations. The primary differential diagnoses include vascular and infectious diseases. The influence of immunomodulatory medications on the pathophysiology of RM remains unclear. There are no consensus guidelines on therapeutic regimen.

methodsWe present four patients with prior history of RA that developed different neurological syndromes in correlation to radiological leptomeningitis. Clinical presentations, comorbid conditions, supplementary diagnostic assessments, treatments, and prognosis are provided. A literature review of recent immunosuppressive management in RM patients was performed.

resultsThree patients presented to hospital with recurrent focal seizures. Only two suffered meningism, reporting headache and fever. Magnetic resonance imaging (MRI) showed different grades of leptomeningitis across all cases. Notably, three cases demonstrated bilateral involvement extending to the pachymeninges. Two patients exhibited pronounced CSF mononuclear inflammation while extended microbiological evaluations yielded negative results. Two patients required biopsy for confirmation. The initiation of immunosuppressive therapy marked a turning point for three patients who previously exhibited progressive deterioration. Mortality was absent in all cases.

conclusionsOur experience remarks the elusive nature of RM. Rigorous exclusionary diagnostics are imperative to differentiate RM from mimicking conditions. Clinical manifestations oscillate between transient episodes and progressive neurological impairments, punctuated by frequent epileptic seizures. In scenarios where clinical worsening persists or where clinical and radiological evaluations are inconclusive, aggressive immunosuppressive therapy is recommended.

Indexed as

Arthritis, RheumatoidMeningitisHumansImmunosuppressive AgentsTreatment OutcomeImmunosuppressive AgentsAseptic meningitisLeptomeningeal enhancementRheumatoid arthritisRheumatoid meningitisRheumatoid vasculitis

Identifiers

PMID39009895

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.