Audio-vestibular dysfunction in rheumatoid arthritis: An undervalued extra-articular feature

Reem Elbeltagy, Dalia Galhom, Marwa Hammad, Ghada A Dawa

Indian Journal of Otology 2018 24(1):47-52

Objective: The study objective was to assess vestibular system either peripherally or centrally in patients with rheumatoid arthritis (RA) using video-nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMP) in an Egyptian group of RA patients and to study whether there is a correlation between hearing levels, VNG, and cVEMP test results. Materials and Methods: This study was a comparative cross-sectional study. A total of forty individuals (twenty apparently healthy controls [40 ears] and twenty RA patients previously diagnosed by a rheumatologist [40 ears]) were included in the study. RA patients were recruited from the Rheumatology and Internal Medicine Departments of Zagazig University Hospitals. All participants gave their written consent before participation in the study. All participants in the study were subjected to basic audiological evaluation and vestibular evaluation (cVEMP-VNG). Results: There was a highly significant difference in VEMP latencies between RA patients and controls (P < 0.001) and nonsignificant difference as regards amplitude (P > 0.05). There was no statistically significant difference in VEMP latencies and amplitude between males and females of the study group (P > 0.05). There was a nonsignificant difference between VEMP latencies and amplitudes among subgroups A and B. All RA patients showed absence of spontaneous gaze-evoked positional and positioning nystagmus, normal oculomotor test, and unilateral caloric weakness in 12 ears. Conclusion: The findings of the current study add more evidence to the cochlea–vestibular involvement in patients with RA. Audio-vestibular function assessment is highly recommended for all RA patients as a routine examination.

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