Parkinsonism with newly diagnosed flare-up rheumatoid arthritis mimicking progressive supranuclear palsy.

Abstract:

:In order to make a correct diagnosis of idiopathic Parkinson's disease (PD), it is essential to exclude atypical parkinsonian features, such as early dementia, fall, and autonomic dysfunction. Rheumatoid arthritis (RA), which is a systemic inflammatory disorder, although most patients present in a polyarticular manner. Still some may also present with extra-articular involvement including skin, lung, heart, and the central or peripheral nervous systems. A possible pathogenetic link between RA and PD are proposed. However, the coexistence of RA and progressive supranuclear palsy (PSP) is rarely reported. Here, we report a parkinsonian patient with a newly diagnosed flare-up RA presenting with early falls, postural instability and supra-nuclear gaze palsy, which suggestive of clinically probable PSP. Furthermore, the parkinsonian features respond to anti-rheumatic agents, but not levodopa. Finally, the patient looks like a clinical possible PD. In summary, Parkinsonian patient with newly diagnosed flare-up RA can present with clinically probable PSP. Unbearably painful limb contracture is a clue of the coexistence of RA. Both typical and atypical parkinsonian features respond dramatically to anti-rheumatic medication, but not levodopa.

journal_name

Neurol India

journal_title

Neurology India

authors

Lee KW,Chien CF,Wu MN,Lai CL,Liou LM

doi

10.4103/0028-3886.284382

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

481-482

issue

2

eissn

0028-3886

issn

1998-4022

pii

ni_2020_68_2_481_284382

journal_volume

68

pub_type

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