A patient with rheumatoid arthritis (RA) may rarely develop rheumatoid meningitis, which may be associated with significant morbidity and even mortality.


Leptomeningitis is meningitis affecting the pia and/or arachnoid membranes.

Pachymeningitis is meningitis affecting the dura mater.


Rheumatoid meningitis may include:

(1) rheumatoid nodules

(2) vasculitis, which can be necrotizing

(3) lymphocytic infiltration of the meninges with or without plasma cells

(4) epithelioid granulomas


Clinical findings:

(1) change in behavior

(2) altered level of consciousness

(3) seizure

(4) cranial nerve dysfunction

(5) hemiparesis or paraparesis


Meningeal enhancement can be seen on MRI.


Laboratory findings:

(1) elevated Rheumatoid factor (RF)

(2) elevated protein in the CSF with a variable iincrease in lymphocytes and monocytes


Most patients with rheumatoid meningitis are known to have rheumatoid arthritis but occasionally a patient will present without arthritis or other manifestations of RA.


Making the diagnosis can be difficult since there is a long differential diagnosis for septic and aseptic meningitis.


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