Extra articular manifestations of rheumatoid arthritis are seen in 10-20% of individuals representing the systemic nature of the disease.20-30%of these, suffer with neuropathic manifestations .It contributes significantly to the disability caused by the disease warranting to pick up those sub clinical cases of neuropathy and to treat them early. Paucity of literature on rheumatoid neuropathy creates a lacuna in critical evaluation and discussion of this subject..

Aim of The Study: It was to find incidence of peripheral neuropathy and their patterns in patients of rheumatoid arthritis and its correlation with severity of the disease and markers of inflammation

Materials And Methods: A cross sectional randomised observational study was conducted in patients diagnosed of rheumatoid arthritis (based on EULAR, ACR2010 criteria) between May 2011-2013 were questioned pertaining to symptoms of neuropathy with special attention to distal symmetric sensory involvement. All individuals were subjected to complete electrophysiological nerve conduction study. Disease severity was assessed with DAS28 scoring system and were tested for inflammatory markers (ESR, CRP, Anti CCP antibodies).

Results: A total of 50 cases of rheumatoid arthritis were analysed and incidence of neuropathy was found in 60%(30/50) with predominantly pure sensory neuropathy 50%(15/30,) sensory motor neuropathy 30% (9/30), mono neuritis multiplex10%(3/30) and carpal tunnel syndrome 10%(3/30). Incidence was found to be more in female sex as is the disease itself and is associated with a DAS 28 score of >5.1 in 96.67%,a positive CRP in 86.6%, ESR of 30-60 mm/hr in 60% and a strongly positive anti-CCP>60 IU in 66.6% individuals.

Conclusion: Peripheral neuropathy in rheumatoid arthritis is relatively a common manifestation with female preponderance and fifty percent of patients having sub clinical neuropathy. Majority have pure sensory type with a mean duration of 55.04 months of illness, severe form of disease and positive inflammatory markers.

Key Words: DAS 28, Extra- Articular manifestation, Peripheral Neuropathy, Rheumatoid Arthritis

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Kumar Rajesh

Consultant Medicine

Bokaro General Hospital (DNB teaching hospital)