Rheumatoid arthritis nerve damage

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

With joint swelling in rheumatoid arthritis (RA),there can be pressure placed on nearby nerves.

If the swelling irritates the nerve, either because of the inflammation or because of pressure, there can be symptoms of pain, numbness, and/or tingling. This is called nerve entrapment. Nerve entrapment most frequently occurs at the wrist (carpal tunnel syndrome) and elbow (ulnar nerve entrapment). It can also affect the foot (tarsal tunnel syndrome). It is important to have nerve entrapment treated early.

A rare form of nerve disease in patients with rheumatoid arthritis that causes numbness and/or tingling is neuropathy. Neuropathy is nerve damage that can result from inflammation of blood vessels (vasculitis).

Vasculitis is not common, but it can be very serious. Rheumatoid vasculitis is an unusual complication of longstanding, severe rheumatoid arthritis. Active vasculitis associated with rheumatoid disease occurs in about 1% of this patient population.

Rheumatoid vasculitis is considered an “extra-articular” (beyond the joint) complication of rheumatoid arthritis and involves the small and medium-sized arteries in the body.

Nerve damage can cause foot or wrist drop, known in medical terminology as “mononeuritis multiplex”. This condition, which may be disabling, is often preceded by a change in sensation in the same area (numbness, tingling, burning, or pain).

These abnormal sensations can progress to muscle weakness, focal paralysis, and eventually to muscle wasting. Recovery from this condition, caused by nerve infarction (nerve death), can take months. In some cases, recovery from mononeuritis multiplex is incomplete.

Another nerve complication with rheumatoid arthritis can occur with spinal involvement that leads to compression of the spinal cord. This is called myelopathy and occurs most commonly in the neck of patients with longstanding rheumatoid disease.

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