Parkinsonism with Newly Diagnosed Flare-up Rheumatoid Arthritis Mimicking Progressive Supranuclear Palsy

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 i...

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Bibliographic Details
Published in:Neurology India 2020-03, Vol.68 (2), p.481-482
Main Authors: Lee, Kuo-Wei, Chien, Ching-Fang, Wu, Meng-Ni, Lai, Chiou-Lian, Liou, Li-Min
Format: Article
Language:English
Subjects:
Arthritis
Brain diseases
Dementia
Diseases
Movement disorders
Parkinson disease
Parkinson's disease
Parkinsonism
Patients
Posture
Progressive supranuclear palsy
Rheumatoid arthritis
Rheumatoid factor
Skin
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Summary: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.
ISSN:0028-3886
1998-4022
DOI:10.4103/0028-3886.284382