Anti-Cyclic Citrullinated Peptide Antibody Index in the Cerebrospinal Fluid for the Diagnosis and Monitoring of Rheumatoid Meningitis

Rheumatoid meningitis (RM) is a rare but often aggressive neurological complication of rheumatoid arthritis. The diagnosis of RM, besides the clinical, radiological, and laboratory criteria, usually requires a cerebral biopsy. Based on the two cases presented in this paper, we propose a new laboratory marker. Cerebrospinal fluid and serum anti-cyclic citrullinated peptide (CCP) IgG were measured, and the intrathecal synthesis of anti-CCP antibodies (anti-CCP antibody index) was calculated using the hyperbolic function. The anti-CCP antibody index was positive in both cases at first diagnosis and progressively decreased after treatments. Together with clinical and radiological criteria, the calculation of the anti-CCP intrathecal synthesis, more than the simple measurement of serum or cerebrospinal fluid anti-CCP antibody titers, may represent a useful tool for RM diagnosis and, possibly, for treatment response.

[1]  Pablo I Alarcón,et al.  Rheumatoid meningitis: A systematic review and meta‐analysis , 2021, European journal of neurology.

[2]  P. Guerne,et al.  Rheumatoid Meningitis a Rare Extra-Articular Manifestation of Rheumatoid Arthritis: Report of 6 Cases and Literature Review , 2020, Journal of clinical medicine.

[3]  Y. Okano,et al.  Anti-cyclic citrullinated peptide antibody in the cerebrospinal fluid in patients with rheumatoid arthritis who have central nervous system involvement , 2020, Clinical Rheumatology.

[4]  C. Bonde,et al.  Use of Cerebrospinal Fluid Biomarkers in Diagnosis and Monitoring of Rheumatoid Meningitis , 2019, Front. Neurol..

[5]  M. Berk,et al.  Rheumatoid meningitis sine arthritis , 2019, Journal of Neuroimmunology.

[6]  S. Cronin,et al.  Rheumatoid arthritis presenting as rheumatoid meningitis , 2019, BMJ Case Reports.

[7]  H. Stan,et al.  Pearls & Oy-sters: Rheumatoid meningitis occurring during treatment with etanercept , 2018, Neurology.

[8]  J. Wetterö,et al.  Changes in anti‐citrullinated protein antibody isotype levels in relation to disease activity and response to treatment in early rheumatoid arthritis , 2018, Clinical and experimental immunology.

[9]  Y. Hasegawa,et al.  Rheumatoid meningitis presenting with a stroke-like attack treated with recombinant tissue plasminogen activator: a case presentation , 2018, BMC Neurology.

[10]  C. Gerloff,et al.  Rheumatoid meningitis: A rare cause of aseptic meningitis with frequently stroke-like episodes , 2018, Neurology. Clinical practice.

[11]  M. Fulham,et al.  Rheumatoid leptomeningitis presenting with an acute neuropsychiatric disorder , 2018, Practical Neurology.

[12]  M. Lyons,et al.  Rheumatoid Meningitis: A Case Review , 2018, The neurologist.

[13]  U. Pohl,et al.  Rheumatoid disease: an unusual cause of relapsing meningoencephalitis , 2018, BMJ Case Reports.

[14]  B. Fiebich,et al.  Do patients with schizophreniform and bipolar disorders show an intrathecal, polyspecific, antiviral immune response? A pilot study , 2017, Fluids and Barriers of the CNS.

[15]  M. Zaffaroni,et al.  Cerebrospinal fluid analysis and the determination of oligoclonal bands , 2017, Neurological Sciences.

[16]  G. Choe,et al.  Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis , 2017, Neurology.

[17]  N. Tachibana,et al.  Rheumatoid Meningitis Occurring during Etanercept Treatment , 2017, Case reports in neurological medicine.

[18]  V. Martinelli,et al.  Free Light Chains and Intrathecal B Cells Activity in Multiple Sclerosis: A Prospective Study and Meta-Analysis , 2016, Multiple sclerosis international.

[19]  T. Kitazono,et al.  Anti-Cyclic Citrullinated Peptide Antibody-Positive Meningoencephalitis in the Preclinical Period of Rheumatoid Arthritis , 2016, Case Reports in Neurology.

[20]  H. Vinters,et al.  Two cases of rheumatoid meningitis , 2016, Neuropathology : official journal of the Japanese Society of Neuropathology.

[21]  B. Roy,et al.  Rheumatoid Meningitis Presenting With Multiple Strokelike Episodes. , 2015, JAMA neurology.

[22]  B. Jahromi,et al.  Rheumatoid-associated meningitis and vasculopathy , 2015, Neurology.

[23]  M. Namekawa,et al.  Parkinsonism as an initial manifestation of rheumatoid meningitis , 2014, Neurological Sciences.

[24]  K. Rijkers,et al.  Rheumatoid arthritis mimicking an intracranial malignancy , 2014, Acta Neurochirurgica.

[25]  A. Inan,et al.  Unusual central nervous system involvement of rheumatoid arthritis: successful treatment with steroid and azathioprine , 2011, Rheumatology International.

[26]  J. Sterne,et al.  Systematic Review: Accuracy of Anti–Citrullinated Peptide Antibodies for Diagnosing Rheumatoid Arthritis , 2010, Annals of Internal Medicine.

[27]  T. Matsui,et al.  Diffuse chronic leptomeningitis with seropositive rheumatoid arthritis: report of a case successfully treated as rheumatoid leptomeningitis , 2009, Modern rheumatology.

[28]  S. Kuzuhara,et al.  Rheumatoid cranial pachymeningitis successfully treated with long-term corticosteroid , 2009, Rheumatology International.

[29]  N. Gilhus,et al.  Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force , 2006, European journal of neurology.

[30]  T. Hashimoto,et al.  Rheumatoid meningitis: an autopsy report and review of the literature , 2003, Clinical Rheumatology.

[31]  Hansotto Reiber,et al.  Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs , 2001, Journal of the Neurological Sciences.

[32]  L. Moreland,et al.  Inflammatory central nervous system involvement in rheumatoid arthritis. , 1989, Seminars in arthritis and rheumatism.

[33]  P. Marusic,et al.  Chronic repetitive nonprogressive epilepsia partialis continua due to rheumatoid meningitis , 2013, Seizure.

[34]  H. Luthra,et al.  An unusual presentation of rheumatoid meningitis. , 2005, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[35]  C. Werning [Rheumatoid arthritis]. , 1983, Medizinische Monatsschrift fur Pharmazeuten.

[36]  A. Richman,et al.  Rheumatoid meningitis. A case report and review of the literature. , 1983, Archives of pathology & laboratory medicine.