No evidence of abnormal metabolic or inflammatory activity in the brains of patients with rheumatoid arthritis: results from a preliminary study using whole-brain magnetic resonance spectroscopic imaging (MRSI)
Open Access
- 30 January 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 39 (6), 1765-1774
- https://doi.org/10.1007/s10067-019-04923-5
Abstract
Introduction/objectives Many individuals with rheumatoid arthritis (RA) report persistent fatigue even after management of peripheral disease activity. This study used whole-brain magnetic resonance spectroscopic imaging (MRSI) to investigate whether abnormal inflammatory activity in the central nervous system may be associated with such symptoms. We hypothesized that RA patients would show higher brain choline (CHO), myo-inositol (MI), and lactate (LAC), and higher brain temperature than healthy controls. We further hypothesized that the metabolite levels would be positively correlated with self-reported fatigue. Method Thirteen women with RA provided fatigue severity ratings and underwent whole-brain MRSI and a joint examination. Thirteen healthy controls (HC) provided comparison imaging and fatigue data. CHO, MI, LAC, and brain temperature in 47 brain regions were contrasted between groups using independent-samples t tests. Significant differences were determined using a false discovery rate (FDR)-adjusted p value threshold of ≤ 0.0023. Secondary analyses obtained correlations between imaging and clinical outcomes in the RA group. Results No brain metabolic differences were identified between the groups. In the RA group, fatigue severity was positively correlated with CHO in several brain regions—most strongly the right frontal lobe (rs = 0.823, p < 0.001). MI was similarly correlated with fatigue, particularly in the right calcarine fissure (rs = 0.829, p < 0.001). CHO in several regions was positively correlated with joint swelling and tenderness. Conclusions We conclude that abnormal brain metabolites are not a common feature of RA, but may been seen in patients with persistent fatigue or disease activity after conventional treatment. Key Points • Whole-brain magnetic resonance spectroscopy revealed no metabolic abnormalities in the brain in patients with rheumatoid arthritis. • Brain choline levels were correlated with fatigue severity reported by RA patients and with peripheral joint swelling and tenderness. • Brain myo-inositol levels were similarly correlated with fatigue severity in RA patients.Funding Information
- Rheumatology Research Foundation (Disease Targeted Research Pilot Grant)
This publication has 44 references indexed in Scilit:
- Potential role for S100A4 in the disruption of the blood–brain barrier in collagen-induced arthritic mice, an animal model of rheumatoid arthritisNeuroscience, 2011
- Serum Cytokine and Periodontal Profiles in Relation to Disease Activity of Rheumatoid Arthritis in Japanese AdultsThe Journal of Periodontology, 2010
- Brain involvement in rheumatoid arthritis: A magnetic resonance spectroscopy studyArthritis & Rheumatism, 2009
- Dissociating anxiolytic and sedative effects of GABAAergic drugs using temperature and locomotor responses to acute stressPsychopharmacology, 2009
- Mapping of brain metabolite distributions by volumetric proton MR spectroscopic imaging (MRSI)Magnetic Resonance in Medicine, 2008
- Empirical optimization of ASL data analysis using an ASL data processing toolbox: ASLtbxMagnetic Resonance Imaging, 2008
- Fatigue in rheumatoid arthritis reflects pain, not disease activityRheumatology, 2006
- Segmentation of brain MR images through a hidden Markov random field model and the expectation-maximization algorithmIEEE Transactions on Medical Imaging, 2001
- Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritisArthritis & Rheumatism, 1995
- The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 1983