Disease activity and cognition in rheumatoid arthritis: an open label pilot studyReport as inadecuate

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Arthritis Research and Therapy

, 14:R263

First Online: 04 December 2012Received: 07 August 2012Revised: 20 November 2012Accepted: 28 November 2012


IntroductionWe hypothesised that fatigue in rheumatoid arthritis RA is related to TNF-alpha induced dysregulation of cerebral blood flow. Our objectives were to assess fatigue, cognitive function and cerebral blood flow before and after initiation of anti-TNF treatment.

MethodsIn a pilot study, 15 patients initiating treatment with adalimumab were assessed for fatigue using a visual analogue scale FACIT-F, cognitive function using a panel of psychometric tests and regional cerebral blood flow using MR perfusion imaging.

ResultsPatients improved clinically after anti-TNF therapy in terms of DAS28 and FACIT-F. Furthermore significant improvements were documented in full scale, verbal and performance IQ following therapy. There was a non-significant trend towards reduced cerebral perfusion in both grey and white matter, and fatigue at 3 months correlated with cerebral blood flow in white p = 0.014 and grey p = 0.005 matter.

ConclusionsWe demonstrate for the first time a significant improvement in cognitive function following effective treatment of RA. Although we observed minor reductions in cerebral blood flow, and a correlation between cerebral blood flow and fatigue, a larger, controlled study would be required to affirm a causal relationship.

AbbreviationsACRAmerican College of Rheumatology

ASLarterial spin labeling

CBFcerebral blood flow

CSFcerebrospinal fluid

DAS2828-joint disease activity score

DMARDdisease-modifying anti-rheumatic drug

FACIT-Ffunctional assessment of chronic illness therapy fatigue scale

FAIRflow-sensitive alternating inversion recovery

IQintelligence quotient

MRImagnetic resonance imaging

NSAIDnon-steroidal anti-inflammatory drug

RArheumatoid arthritis

rCBFregional cerebral blood flow

ROIregion of interest

SPMStatistical Parametric Mapping

TNFtumour necrosis factor

WAIS-IIIWechsler adult intelligence scale III.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4108 contains supplementary material, which is available to authorized users.

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Author: Graham Raftery - Jiabao He - Ruth Pearce - Daniel Birchall - Julia L Newton - Andrew M Blamire - John D Isaacs

Source: https://link.springer.com/

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