Electrophysiological Profile of Neuropathy in Rheumatoid Arthritis Patients: A Cross-sectional Study

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory condition that mainly affects the small joints of hands and legs. Peripheral neuropathy is one of the most common manifestations of Rheumatic disease. Aim: To describe the electrophysiological profile of neuropathy in RA patients attending the Rheumatology Clinic of a Medical College in Southern India. Materials and Methods: The present cross-sectional study was conducted in Department of Rheumatology, Coimbatore medical college, Coimbatore, Tamil Nadu, India, between September 2019 and September 2020. A total of 50 consecutive patients diagnosed with RA based on American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria 2010, with disease duration more than two years were included in the study. Clinical examination, Erythrocyte Sedimentation Rate (ESR), Rheumatoid Factor (RF), Renal Function Tests (RFT), Liver Function Tests (LFT), Complete Blood Count (CBC), Human Immunodeficiency Virus (HIV) antibody testing, blood sugar and Nerve Conduction Studies (NCS) were performed in patients satisfying inclusion and exclusion criteria. Chi-square test was used to compare proportions of categorical variables and t-test was used to compare means across groups with various types of axonal neuropathy. Results: Of 50 patients with RA, 37 (74%) patients had peripheral neuropathy electrophysiologically, whereas 27% (10 patients of 37) had sensory symptoms. Subclinical neuropathy was present in 73% (27 patients out of 37) of patients. Mixed non-compressive neuropathy of the lower limb was most common 25 (50%) Statistically significant association was found between the presence of neuropathy and RF positivity and also with duration of illness. No association was found with age, sex, ESR levels. Conclusion: Prevalence of subclinical peripheral neuropathy is very common among patients with RA. Electrophysiological studies can detect peripheral neuropathy earlier. Hence, all RA patients should undergo NCS periodically to detect neuropathy early and to prevent development of complication related to it.