{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:40:07Z","timestamp":1756320007545,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,10,17]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>Rheumatoid arthritis (RA) is a multisystem inflammatory disease which can involve many organ systems including the central nervous system (CNS). Though not very common, the results can be severely debilitating. The spectrum of the CNS involvement includes meningitis, encephalitis and occasionally rheumatoid nodules. Its presentation is variable, though very rarely it can present as focal neurological deficits. Imaging can be suggestive, but diagnosis usually requires tissue biopsy. Treatment consists of high-dose steroids and immunosuppressants. We describe the case of a 55-year-old male patient with a history of RA presenting with a third nerve palsy and headache who was found to have rheumatoid nodules on biopsy. CNS involvement in RA should be considered in anyone with rheumatoid arthritis who presents with focal neurological deficits, though infections and space-occupying lesions should also be ruled out.<\/jats:p>","DOI":"10.1136\/bcr-2019-231474","type":"journal-article","created":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T04:45:14Z","timestamp":1575953114000},"page":"e231474","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Meningeal rheumatoid nodules in a 55-year-old man presenting with chronic headaches and oculomotor nerve palsy: an uncommon extra-articular manifestation of rheumatoid arthritis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-6997","authenticated-orcid":false,"given":"Hafez Mohammad Ammar","family":"Abdullah","sequence":"first","affiliation":[{"name":"Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Omar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiham","family":"Jbeli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Fanciullo","sequence":"additional","affiliation":[{"name":"Rheumatology, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,12,9]]},"reference":[{"key":"2025082711160471000_12.12.e231474.1","doi-asserted-by":"publisher","DOI":"10.1016\/0049-0172(89)90047-4"},{"key":"2025082711160471000_12.12.e231474.2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(195912)2:6<537::AID-ART1780020608>3.0.CO;2-Q"},{"key":"2025082711160471000_12.12.e231474.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(84)90787-3"},{"key":"2025082711160471000_12.12.e231474.4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1552-6569.2005.tb00325.x","article-title":"An unusual presentation of rheumatoid meningitis","volume":"15","author":"Chowdhry","year":"2005","journal-title":"J Neuroimaging"},{"key":"2025082711160471000_12.12.e231474.5","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000257824.72457.91"},{"key":"2025082711160471000_12.12.e231474.6","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1007\/s00415-009-5286-0","article-title":"Infliximab in the treatment of rheumatoid meningoencephalitis","volume":"256","author":"Luessi","year":"2009","journal-title":"J Neurol"},{"key":"2025082711160471000_12.12.e231474.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2009.01.033"},{"key":"2025082711160471000_12.12.e231474.8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/j.1552-6569.2008.00299.x","article-title":"Rheumatoid leptomeningitis: magnetic resonance imaging and pathologic findings-a case report","volume":"20","author":"Cianfoni","year":"2010","journal-title":"J Neuroimaging"},{"key":"2025082711160471000_12.12.e231474.9","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jbspin.2011.07.008","article-title":"Rheumatoid meningitis occurring during adalimumab and methotrexate treatment","volume":"79","author":"Huys","year":"2012","journal-title":"Joint Bone Spine"},{"key":"2025082711160471000_12.12.e231474.10","doi-asserted-by":"publisher","DOI":"10.1007\/s13760-012-0021-5"},{"key":"2025082711160471000_12.12.e231474.11","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00701-013-1936-1","article-title":"Rheumatoid arthritis mimicking an intracranial malignancy","volume":"156","author":"Rijkers","year":"2014","journal-title":"Acta Neurochir"},{"key":"2025082711160471000_12.12.e231474.12","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2014-208745","article-title":"Rheumatoid meningitis: a rare complication of rheumatoid arthritis","volume":"2015","author":"Lu","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2025082711160471000_12.12.e231474.13","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001306"},{"key":"2025082711160471000_12.12.e231474.14","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2019.00163","article-title":"Rheumatoid meningitis presenting with acute parkinsonism and protracted Non-convulsive seizures: an unusual case presentation and review of treatment strategies","volume":"10","author":"Pellerin","year":"2019","journal-title":"Front Neurol"},{"key":"2025082711160471000_12.12.e231474.15","doi-asserted-by":"crossref","first-page":"317","DOI":"10.2176\/nmc.cr2012-0259","article-title":"Multiple intracranial nodules associated with rheumatoid arthritis: case report","volume":"54","author":"Takahashi","year":"2014","journal-title":"Neurol Med Chir"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231474","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:16:15Z","timestamp":1756318575000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":15,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12,9]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/bcr-2019-231474"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231474","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,12]]}}}