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Neurovascular mechanisms as a possible cause of remission of rheumatoid arthritis in hemiparetic limbs

In patients with rheumatoid arthritis (RA), ischaemic stroke frequently leads to an unexplained remission of the arthritis in the paretic limb. Here we present two cases which suggest that neurovascular mechanisms contribute to the asymmetry of inflammation by impairing the microcirculation in the paretic extremity.

A 47 year old man developed RA in 1988. In 1990, he had an apoplectic insult, resulting in a complete, left sided hemiplegia. The right hand had a marked ulnar drift of the metacarpophalangeal (MCP) joints and an inflamed wrist with impaired motion, whereas the left hand showed no inflammation or deformity. An x ray analysis of the right hand demonstrated carpal ankylosis and subluxation and erosion of all MCP joints. The left hand showed no erosive changes (fig 1A). Thermal imaging indicated marked temperature differences between both hands, most obvious at the wrists (fig 1B). Duplex sonography measured no detectable flow …