Early detection of cervical myelopathy in some rheumatic diseases using somatosensory and motor evoked potentials

Abstract EN

Theory : neurological affection in rheumatoid arthritis (RA), systemic lupus erythematous (SLE) and systemic sclerosis (SSc) may be subclinical but once they occur, they are irreversible and add an extra burden and suffering to the patient's lives.

Early detection of such disease subclinical neurological affection helps a lot in the early intervention to prevent and avoid the irreversible damage to the nervous system.

Objective : to characterize the neurological manifestations in RA, SLE and SSc and to obtain the electro-physiological documentation of possible cervical myelopathy.

Methodology : Twenty four RA patients, 11 SLE patients, and 9 SSC patients were included in this study.

Thirty control age and sex matched persons were also enrolled.

All subjects were submitted to the following : clinical and systemic examination, rheumatologic and neurological examinations for signs of myelopathy or neuropathy.

Laboratory studies included complete blood count, liver function tests, kidney function tests, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and quantitative Rheumatoid factor tests.

Specific tests were anti-nuclear antibody (ANA), anti–double stranded DNA (ds-DNA), anti SCL70, and Anti cardiolipin antibodies.

Somatosensory and motor evoked potentials (SSEP, MEP) of upper limbs were recorded.

Results : Overt neurological signs were found in 50 % of SLE patients, which are much more than that found in RA (29 %) and SSC (22.2 %).

Clinical cervical myelopathy was recorded in 40 % in SLE, 22.2% in SSC and 16.7 % in RA.

Cervical myelopathy was detected with SSEP and MEP in 50% of SLE, 66.6 % in SSC, and 20.8 in RA.

There was a significant correlation between central conduction time with rheumatoid factor (p = 0.017), anticardiolipin antibody (p = 0.001), and anti-ds DNA antibody (p = 0.00!) in RA.

Conclusion: The results support that SSEP and MEP are the most reliable data evaluating the risk of cervical myelopathy in some rheumatic diseases.