SINCE the introduction of the term "collagen diseases," 1 the concept of an intimate relationship between these apparently disparate disorders has been the subject of considerable interest and controversy. One of the characteristic features of these syndromes is the involvement of multiple body systems, but, thus far, the frequency and importance of central nervous system (CNS) manifestations have not been accorded proper recognition. Neuropathologic lesions have been reported sporadically in disseminated lupus erythematosus* and polyarteritis nodosa,† but the commoner, "rheumatic" members of this group have been virtually ignored.
Interest in this aspect of these disorders was stimulated during a recent study 8 by the unexpected, and heretofore unreported, finding of significant, although subclinical, mental deficit in certain patients with rheumatoid arthritis. No basis for this intellectual impairment could be detected, other than the arthritic process itself. These patients exhibited no overt neurologic abnormalities.
A subsequent survey of the literature provided