Neuropathic manifestations in rheumatoid arthritis : A clinical and electrophysiological assessment in a small sample of Iraqi patients.

Rheumatoid arthritis (RA) is an inflammatory systemic diseasemainly affecting joints. Frequent extra-articular manifestationsare often recognized too late. Extra-articular manifestations affect the skin, the cardiovascular system, the kidneys, the eyes, thegastrointestinal tract, the liver, the nervous system and the blood. In aretrospective cohort study of 489 RA patients admitted to UniversityHospital, Malmo, Sweden, during the period 1990-94, it was found thatserositis and cutaneous vasculitis were the predominant extra-articularmanifestations of rheumatoid arthritis (ExRA), and mortality was greater in the ExRA than in the non-ExRA subgroup, perhaps due toa high frequency of associated heart disease.1 In another retrospectivecohort study of 424 cases of RA, classified by the American College ofRheumatology 1987 criteria for RA in Olmsted County, MN, USA, anddiagnosed during the period 1955-1985, the investigators found that theincidence of extra-articular manifestations was 3.67/100 person-years.2 In addition, it has been found that survival among rheumatoid pa-tients with extra-articular manifestations was markedly decreased com-pared to the general population and to patients without extra-articular manifestations.2 Clinical involvement of the peripheral nervous sytem is not uncommon in rheumatoid arthritis; the most common disorders are multiple mononeuritis, sensorimotor neuropathy, and entrapment neuropathy.Rheumatoid patients may have electrophysiologic and histologic findings of peripheral nerve damage, even in the absence of clinical evi-dence of peripheral nerve involvement. Lanzillo et al reported that 65% of cases exhibited electrophysiologic findings consistent with a senso-rimotor neuropathy in rheumatoid patients without clinical symptoms or signs of peripheral nerve involvement.3 Necrotizing vasculitis is responsible for the different patterns of noncompressive neuropathies in rheumatoid arthritis, including mononeuritis multiplex and distal symmetric sensory or sensorimotor neuropathy.4 In Said fs series of 200 patients with peripheral nerves vasculitis, 21% were due to rheumatoid arthritis.5 The present study aimed to assess the pattern of neurological manifestations in a small sample size of rheumatoid patients in Baghdad based on neurological examination and electrophysiological studies.