A neurologist does not manage the underlying systemic disease of Rheumatoid Arthritis (RA). RA is a chronic autoimmune inflammatory disorder where the body’s immune system mistakenly attacks the lining of the joints, called the synovium. This attack causes inflammation, swelling, and pain, primarily affecting joints symmetrically, most commonly in the hands and wrists. Although known for its impact on joints, RA is a systemic disease that can also affect organs like the lungs, eyes, heart, and nerves. The systemic inflammatory nature of RA is exclusively managed by a different medical specialist.
The Primary Role of Rheumatology
The medical specialist responsible for the overall treatment and management of Rheumatoid Arthritis is the rheumatologist. This physician focuses on controlling the systemic inflammation driving the disease, aiming to reduce joint damage and preserve function. The primary goal of treatment is to achieve remission or low disease activity, which slows the progression of joint destruction.
Rheumatologists use powerful medications to modulate the immune system’s attack on the joints. These include Disease-Modifying Antirheumatic Drugs (DMARDs), such as methotrexate, leflunomide, and sulfasalazine, which slow joint damage progression. If conventional DMARDs are insufficient, biologic agents may be introduced. Biologics are molecules that target specific inflammatory proteins, such as tumor necrosis factor (TNF) inhibitors or interleukin inhibitors.
Short courses of corticosteroids, such as prednisone, are also prescribed to quickly ease inflammation and pain. These are often used while waiting for the DMARDs to take full effect. The rheumatologist selects and adjusts this complex medication regimen to manage the root cause of the autoimmune inflammation and prevent systemic complications.
Neurological Manifestations of Rheumatoid Arthritis
While the rheumatologist manages the autoimmune process, the systemic inflammation of RA can lead to secondary complications that affect the nervous system. These manifestations result from either direct compression by inflamed tissue or from nerve damage caused by the inflammation itself.
One of the most common issues is entrapment neuropathy, where swollen joints and inflamed tissues compress a peripheral nerve. Carpal Tunnel Syndrome (CTS) is the most frequent example, caused by swelling around the wrist compressing the median nerve. Patients may experience numbness, tingling, or weakness in the hand.
Rheumatoid inflammation can also cause non-compressive peripheral neuropathy, often affecting sensory or sensorimotor function. This nerve damage can result from vasculitis, a severe form of blood vessel inflammation. Symptoms may include distal sensory loss or a painful burning sensation, often indicating heightened disease activity.
A particularly serious manifestation involves the cervical spine, where the disease can cause instability. Synovial inflammation in the upper neck joints leads to erosion of ligaments and bone, resulting in atlantoaxial subluxation. This instability causes one vertebra to slip over another, potentially compressing the spinal cord (myelopathy). Symptoms of spinal cord compression include gait instability, impaired hand dexterity, and weakness in the arms and legs.
When a Neurologist Becomes Involved
A neurologist becomes involved when secondary neurological complications arise in an RA patient. Their focus is on diagnosing and treating the effects of RA on the nervous system, not managing the underlying autoimmune disease. The neurologist’s expertise addresses the specific nerve damage or compression causing symptoms.
Diagnosis and Assessment
Diagnosis often involves specialized tests like nerve conduction studies and electromyography to assess peripheral nerve damage. For suspected spinal cord involvement, the neurologist uses imaging techniques such as Magnetic Resonance Imaging (MRI). This visualizes the degree of nerve or cord compression, allowing for precise identification of the pathology.
Treatment Strategies
Treatment centers on symptom management and nerve protection. For peripheral neuropathy, they may prescribe medications specifically designed to control nerve pain, which differ from the DMARDs used for RA. In cases of severe spinal cord compression, the neurologist works with a neurosurgeon to determine the need for surgical decompression and spinal fusion.
The overall care for an RA patient with neurological symptoms is a collaborative effort. The neurologist manages the nerve and spinal issues, while the rheumatologist continues to treat the systemic inflammation with DMARDs and biologics. This shared approach ensures both the primary disease and its secondary effects are addressed effectively.