A Case Of Rheumatoid Meningitis With Elevated Antibody Titer Indices Of Anti-Cyclic Citrullinated Peptide Antibody And Anti-Galactose-Deficient Igg Antibody

Rheumatoid meningitis (RM) is a rare central nervous system manifestation of rheumatoid arthritis (RA). A meningeal biopsy is useful for diagnosis but is invasive and not very sensitive. We report about a patient with RM who was diagnosed using indices of anti-cyclic citrullinated peptide (CCP) antibody and anti-galactose-deficient IgG antibody (carbohydrate in rheumatoid factor [CARF]) and who had refused to undergo biopsy. The patient's antibody titer indices of anti-CCP antibody and CARF were 21.01 and 4.44, respectively. The patient's symptoms and abnormalities on brain magnetic resonance imaging improved after steroid therapy. Antibody titer indices of the anti-CCP antibody and CARF can be used to diagnose RM in cases where biopsy is unavailable.