| Cerebral vasculitis in a patient with rheumatoid arthritis. | |
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MedLine Citation:
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PMID: 17336121 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Inflammatory vasculitis of the central nervous system is exceedingly rare in patients with rheumatoid arthritis (RA). The symptoms may be misleading. Most of the reported cases occurred in males with long-standing, nodular, destructive, rheumatoid factor-positive disease. Severe constitutional symptoms and prominent extraarticular manifestations of vasculitis were usually present. We report a case of cerebral vasculitis in a 59-year-old woman with a 20-year history of destructive rheumatoid factor-positive RA that was well controlled by methotrexate. Headache that was unresponsive to symptomatic treatment developed abruptly, together with gait disorders. Magnetic resonance imaging of the brain showed dot-like areas of high-signal in a periventricular subcortical distribution on both sides. Magnetic resonance angiography visualized a long tight stenosis of the right internal carotid artery and a string-of-beads stenosis of the left internal carotid artery suggesting vasculitis. Pulse therapy with methylprednisolone (1 g/d for 3 days) and cyclophosphamide (1 g) once a month ensured resolution of the neurological symptoms and laboratory evidence of inflammation. There was no evidence of a relapse at last follow-up after 5 months. Cerebral vasculitis is usually treated with monthly glucocorticoid and cyclophosphamide boluses separated by continuous glucocorticoid therapy. TNFalpha antagonists may be effective in patients who fail to respond to conventional treatment. However, other vasculitides such as giant cell arteritis and Wegener's granulomatosis must be ruled out, as they are refractory to TNFalpha antagonist therapy. |
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Authors:
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Dalila Mrabet; Nihel Meddeb; Houda Ajlani; Hela Sahli; Slaheddine Sellami |
Publication Detail:
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Type: Case Reports; Journal Article Date: 2007-02-06 |
Journal Detail:
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Title: Joint, bone, spine : revue du rhumatisme Volume: 74 ISSN: 1778-7254 ISO Abbreviation: Joint Bone Spine Publication Date: 2007 Mar |
Date Detail:
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Created Date: 2007-04-24 Completed Date: 2007-06-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100938016 Medline TA: Joint Bone Spine Country: France |
Other Details:
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Languages: eng Pagination: 201-4 Citation Subset: IM |
Affiliation:
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Rheumatology Department, La Rabta Hospital, Tunis 1006, Tunisia. mrabetdalila@yahoo.fr <mrabetdalila@yahoo.fr> |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antirheumatic Agents
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therapeutic use Arthritis, Rheumatoid / complications*, drug therapy Cyclophosphamide / therapeutic use Drug Therapy, Combination Female Gait Disorders, Neurologic / etiology Glucocorticoids / therapeutic use Headache / etiology Humans Magnetic Resonance Angiography Methylprednisolone / therapeutic use Middle Aged Treatment Outcome Vasculitis, Central Nervous System / diagnosis, drug therapy, etiology* |
| Chemical | |
Reg. No./Substance:
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0/Antirheumatic Agents; 0/Glucocorticoids; 50-18-0/Cyclophosphamide; 83-43-2/Methylprednisolone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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