Brain involvement in rheumatoid arthritis: A magnetic resonance spectroscopy study

Abstract

Objective. Tumor necrosis factor ␣ was recently implicated as an important mediator of communication between the peripheral and cerebral immune systems in an animal model of chronic inflammation. The purpose of this study was to examine by proton magnetic resonance spectroscopy ( 1 H-MRS) the influence of inflammation on cerebral metabolism in patients with rheumatoid arthritis (RA).Methods. Single-voxel 1 H-MRS of the centrum semiovale was performed on 35 RA patients (6 men and 29 women; mean ؎ SD age 51.8 ؎ 14.6 years) and 28 healthy age-and sex-matched control subjects (9 men and 19 women; mean ؎ SD age 50.2 ؎ 10.4 years). None of the study subjects had any neurologic signs or symptoms. Clinical markers of disease activity were correlated with the 1 H-MRS findings.Results. Patients with active RA, as reflected by an elevated erythrocyte sedimentation rate (ESR), had a significantly higher ratio of choline to creatine and a significantly lower ratio of N-acetylaspartate to choline than did patients with inactive RA, as reflected by a normal ESR. Moreover, the ratios of choline to creatine and NAA to choline were significantly correlated with the ESR after correction for age, sex, smoking status, handedness, alcohol consumption, medication use, and disease duration. Medication use had no additional effect on these associations. Conclusion.Our data show that systemic inflammation in RA is associated with metabolic changes in the brain.

1H-magnetic resonance spectroscopy indicates damage to cerebral white matter in the subacute phase after CO poisoning

“…The mean Cho/Cr and mean NAA/Cr ratios for the centum semiovale in healthy volunteers in this study were similar to the range of 0.89–1.09 for Cho/Cr and 1.64–2.20 for NAA/Cr reported in previous studies 31 32. These results confirm the reliability of the MRS data obtained in the present study.…”

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)

“…2 Mean CHO/CR ratios across the brain in the RA and control group. There were no significant differences in CHO/CR in any of the assessed regions of interest be positively correlated with erythrocyte sedimentation rate in RA [27]. These results suggest that higher CHO levels throughout the brain may be meaningfully associated with RA disease severity, and may contribute to fatigue severity.…”

“…To our knowledge, only one previous study has examined brain levels of CHO, LAC, or NAA in RA versus healthy controls. Emmer and colleagues [27] reported no significant differences between RA patients and controls in CHO, LAC, or NAA when performing single-voxel spectroscopy in the centrum semiovale. We are also aware of only one PET study using a translocator protein (TSPO) radioligand to examine possible brain inflammation in RA versus controls.…”

New insights into the impact of neuro-inflammation in rheumatoid arthritis

“…In the Steens study (Steens et al, 2005) 1H MRS of a single white matter region adjacent to the left ventricle almost reached a significant difference in metabolite levels between RA patients and controls. A subsequent retrospective analysis showed that a high choline to creatine (Cho/Cr) metabolite ratio was associated with high ESR levels and correlated with ESR and disease activity after correction for disease activity and duration (Emmer et al, 2009). There was no difference in N-acetyl aspartate to creatine (NAA/Cr) ratio or correlation with ESR, suggesting there was no neuronal damage, which is consistent with the lack of major neurological symptoms in RA, unlike for lupus.…”

“…Elevated choline is found in lupus and other neuroinflammatory diseases (Axford et al, 2001). Choline has a function in cell membrane synthesis and its elevation in RA may relate to microglial activation or monocyte infiltration (Emmer et al, 2009). Brain metabolic changes have been associated with pain processing regions in a number of studies and elevation of the combined neurotransmitters glutamate and glutamine observed in fibromyalgia patients (Fayed et al, 2010) and also with induced pain (Gussew et al, 2010).…”