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Rheumatoid Vasculitis — SCE Rheumatology MCQ

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ModerateRheumatology EmergenciesRheumatoid VasculitisSCE Rheumatology

A 60-year-old man with long-standing, seropositive erosive rheumatoid arthritis and rheumatoid nodules develops painful paraesthesia over the dorsum of his right foot followed by right foot drop. Ten days later, he develops numbness of the left little and ring fingers with weakness of finger abduction. Which neurological complication is most likely?

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Correct answer: E — Mononeuritis multiplex due to rheumatoid vasculitis

The correct answer is E. Painful, acute-to-subacute and sequential sensorimotor deficits in anatomically separate peripheral nerves constitute mononeuritis multiplex. In a patient with long-standing seropositive, erosive and nodular rheumatoid arthritis, this should prompt urgent assessment for rheumatoid vasculitis affecting the vasa nervorum. Neurophysiology typically demonstrates a multifocal axonal neuropathy, and tissue biopsy may be required for confirmation. A lumbar disc prolapse cannot explain deficits in both a lower-limb and an upper-limb nerve territory. Isolated common peroneal entrapment would not account for the subsequent ulnar neuropathy. Cervical myelopathy causes long-tract upper motor neurone findings rather than sequential peripheral nerve lesions. Motor neurone disease does not produce sensory symptoms.

Reference: Ruffer N, et al. Vasculitic involvement of the skeletal muscle and the peripheral nervous system: clinical and neuropathologic perspective. Z Rheumatol. 2025;84(3):210-218. https://pubmed.ncbi.nlm.nih.gov/39316132/