Sudden Paralysis: Risks for Autoimmune Patients

Sudden paralysis lasting for a few minutes?

Hello, Doctor Gao.
I am RA.
In addition to RA, I also have some suspected autoimmune diseases (SLE) that are being monitored.
This past weekend, I did some cleaning at home in the morning.
While I was cleaning, I didn't feel any strain, but when I woke up from my noon nap and tried to get up, I found that I couldn't stand at all.
I struggled to stand, but my legs wouldn't cooperate, and I experienced pain in my sacral area, along with a sensation of misalignment in my bones.
I had to lie down for a while before I could slowly move my legs and stand up despite the pain.
Walking was very painful at first, but after some time, it gradually improved.
I was quite frightened by this situation and am unsure what it means.
Is this related to my RA? Does it indicate that I am at risk of paralysis in the future? (I recall that I had elbow pain a year ago and had an X-ray of my cervical spine, which showed significant lordosis; I wonder if this is an extension of the same issue?) Thank you very much for taking the time to respond.

bei xia dao, 40~49 year old female. Ask Date: 2014/03/23

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
If the pain is sudden and improves gradually after rest, it is likely a temporary muscle strain due to excessive exertion, so there is no need to worry.
However, if you have rheumatoid arthritis (RA) and are on long-term medication, you should be cautious about the risk of osteoporosis.
Severe osteoporosis can lead to vertebral compression fractures due to sudden changes in posture, resulting in persistent pain in the lower back, which would not improve quickly like your current symptoms.

RA can also lead to cervical spine dislocation, which is different from the condition of kyphosis, so it is important to confirm this with your physician.
Cervical dislocation is a serious issue that requires careful monitoring, and surgery may be necessary if needed, as it can lead to neurological complications, which is also different from your symptoms.

In general, we recommend that patients with RA regularly measure their bone density, supplement calcium as needed, and engage in exercise as tolerated by their joint symptoms.
This approach helps to strengthen bone density and maintain muscle coordination, significantly reducing the chances of experiencing acute muscle and joint pain in the future.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2014/03/23

More Info

Sudden paralysis or weakness, particularly in patients with autoimmune diseases like rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), can be alarming and may indicate a variety of underlying issues. Your experience of sudden inability to stand, accompanied by pain and a sensation of misalignment in your bones, raises several important considerations.

Firstly, it is crucial to understand that autoimmune diseases can affect the nervous system in various ways. In RA, for instance, inflammation can lead to joint damage and may also affect nearby nerves, potentially causing symptoms like weakness or pain. Additionally, SLE can lead to neurological complications, including lupus myelitis or peripheral neuropathy, which can manifest as weakness or sensory changes.

The sudden onset of paralysis you experienced could be attributed to several factors:
1. Muscle Fatigue or Weakness: Autoimmune diseases can lead to muscle inflammation (myositis) or generalized fatigue, which may cause temporary weakness. If you were engaging in physical activity that your body was not accustomed to, it could have exacerbated underlying muscle weakness.

2. Nerve Compression: Given your history of neck issues, such as the significant reversal of the cervical lordosis (which can lead to nerve compression), it is possible that certain positions or movements could have exacerbated nerve compression, leading to temporary paralysis or weakness.

3. Inflammatory Flare: Autoimmune diseases often have periods of exacerbation or flare-ups. If you were experiencing an inflammatory flare, it could have contributed to your symptoms.

4. Vascular Issues: Autoimmune diseases can also increase the risk of vascular complications, such as vasculitis, which can affect blood flow to the nerves and muscles, leading to weakness or paralysis.

5. Psychological Factors: Anxiety and stress can also manifest physically, leading to muscle tension and weakness. The fear of paralysis can create a cycle of tension that exacerbates physical symptoms.

Given these possibilities, it is essential to consult with your healthcare provider to discuss your symptoms in detail. They may recommend further evaluations, such as imaging studies (MRI of the cervical spine), nerve conduction studies, or blood tests to assess inflammation levels and rule out other complications.

In terms of future risks, while experiencing sudden paralysis can be concerning, it does not necessarily indicate that you will face permanent paralysis. However, it does highlight the importance of monitoring your symptoms closely and maintaining regular follow-ups with your rheumatologist or neurologist. They can help you manage your autoimmune conditions effectively and address any neurological symptoms that arise.

In summary, your sudden paralysis could be related to your autoimmune conditions, but it is essential to investigate further to determine the exact cause. Early intervention and management can help mitigate risks and improve your quality of life. Always prioritize open communication with your healthcare team to ensure that your concerns are addressed promptly and effectively.

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