Peripheral Polyneuropathy in Rheumatoid Arthritis in the Elderly
Yes, rheumatoid arthritis (RA) can cause peripheral polyneuropathy in elderly patients, with prevalence rates ranging from 17-75% depending on diagnostic methods used.
Prevalence and Clinical Significance
Peripheral neuropathy is a recognized extra-articular manifestation of RA, with studies showing:
- Up to 75.28% of RA patients may have peripheral neuropathy when assessed electrophysiologically 1
- Approximately 17% of RA patients demonstrate polyneuropathic involvement in nerve conduction studies 2
- Subclinical neuropathy is present in about 50.74% of RA patients with peripheral neuropathy 1
- Only 20.89% of patients with electrophysiologically confirmed neuropathy have clinically detectable sensory loss on examination 1
Types of Neuropathy in RA
The most common patterns of peripheral neuropathy in RA patients include:
- Polyneuropathy (60.0%) - most predominant form 3
- Mononeuritis multiplex (31.1%) 3
- Mild symmetric sensory neuropathy 2
- Mild symmetric sensorimotor axonal polyneuropathy 2
- Carpal tunnel syndrome (both unilateral and bilateral) 4
Risk Factors for Peripheral Neuropathy in RA
Several factors increase the risk of developing peripheral neuropathy in elderly RA patients:
- Advanced age: Elderly patients with RA are at significantly higher risk (mean age 69.4 years in those with neuropathy vs. 56.5 years without) 4
- Longer disease duration: Significantly associated with polyneuropathy development 2
- Higher disease activity: Higher DAS28 scores increase risk of polyneuropathy three-fold 2
- High rheumatoid factor levels: RF >178.4 IU/ml increases risk 5.6-fold 3
- Anti-CCP antibody positivity: Significant relationship found between peripheral neuropathy and anti-CCP antibody 4
- Presence of cutaneous vasculitis: Higher percentage in RA patients with peripheral neuropathy 3
Clinical Presentation
The most common symptoms of peripheral neuropathy in RA patients include:
Diagnostic Approach
Diagnosis of peripheral neuropathy in elderly RA patients should include:
Clinical evaluation:
- Assessment using Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) 2
- Evaluation for sensory loss and muscle weakness
Electrophysiological testing:
Treatment Options
Management of peripheral neuropathy in elderly RA patients may include:
- High-dose glucocorticoids: Effective in relieving paresthesia in approximately 58.7% of patients 3
- Intravenous immunoglobulins (IVIG): Used in combination with glucocorticoids for better outcomes 3
- Disease-modifying antirheumatic drugs (DMARDs): Early introduction of methotrexate may be beneficial, particularly in patients at high risk for complications 5
Prognosis and Monitoring
- With appropriate treatment, paresthesia can be relieved in the majority of patients (83.3% in follow-up studies) 3
- Complete remission is possible but less common (8.3% of followed cases) 3
- Regular monitoring of neuropathic symptoms should be incorporated into the routine care of elderly RA patients
Clinical Implications
The presence of peripheral neuropathy in RA patients is significantly associated with:
- Deteriorating health status 1
- Higher pain scores 1
- Presence of other extra-articular manifestations 1
- Functional disability as measured by Health Assessment Questionnaire (HAQ) 2
Conclusion
Peripheral polyneuropathy is a common but often underdiagnosed extra-articular manifestation of RA in elderly patients. Clinicians should maintain a high index of suspicion, particularly in elderly patients with high disease activity, positive RF, anti-CCP antibodies, and long disease duration. Electrophysiological testing should be performed routinely in these patients, even in the absence of overt neurological symptoms, as early diagnosis and treatment can significantly improve outcomes and quality of life.