Fatigue in Ankylosing Spondylitis Is Associated With the Brain Networks of Sensory Salience and Attention

Abstract

Objective. Fatigue is one of the cardinal features of ankylosing spondylitis (AS) and contributes substantially to the disability associated with this disease. The mechanisms underlying fatigue in AS remain poorly understood, and this has hampered the development of targeted, effective treatment of this disabling feature of AS. The current study was undertaken, therefore, to investigate the brain networks underlying fatigue in AS.Methods. Twenty patients with back pain secondary to AS (15 men and 5 women; mean ؎ SD age 34.8 ؎ 11.9 years) and 20 age-and sex-matched controls consented to participate in the study. Patients underwent clinical assessment of AS using the Fatigue Severity Scale, the Affect Intensity Measure, and the McGill Pain Questionnaire. Brain gray matter and white matter connectivity was assessed using 3T magnetic resonance imaging.Results. The patients with AS had significant fatigue that correlated with measures of their emotional strength and spinal mobility. Individual fatigue scores were negatively correlated with the amount of gray matter in areas of the dorsal and ventral attention networks, the somatosensory cortices, and the caudate nucleus, but were positively correlated with gray matter within the executive control network and putamen. Moreover, in patients with high fatigue scores, white matter tracts connecting these brain structures (e.g., inferior fronto-occipital fasciculi, superior/inferior longitudinal fasciculi, and corticothalamic tracts) exhibited low fractional anisotropy (indicative of decreased white matter tract integrity).Conclusion. These data indicate that fatigue in AS involves sensory salience and attention brain networks.

Abnormal Resting‐State Neural Activity and Connectivity of Fatigue in Parkinson's Disease

“…Coincidentally, a recent study of a patient with right MFG resection clarified that right MFG was a crucial node of attentional circuits, and it controlled over both ventral and dorsal attention networks . What's more, some evidence has already illuminated that attention deficit may be related to the presence of fatigue . For example, Jau‐Shin Lou et al reported PD patients with fatigue had abnormal attention network compared with controls.…”

“…For example, Jau‐Shin Lou et al reported PD patients with fatigue had abnormal attention network compared with controls. Moreover, Qi Wu et al revealed fatigue in ankylosing spondylitis patients were correlated with the dorsal and ventral attention networks. In this study, the results of decreased ALFF in right MFG and altered FC between right MFG and right middle temporal gyrus and left superior parietal gyrus further suggested that impaired attention network was likely involved in fatigue of PD.…”

Tumor necrosis factor inhibitor therapy in ankylosing spondylitis

“…19 The PCS (range 0-52 31 and the 40-item 6-point scale AIM 8 were used to assess the cognitive/affective functions as previously described. 40 The painDETECT Questionnaire 11 was used to determine the neuropathic component of AS pain.…”

“…Previous studies report a considerable residual fatigue in patients with AS after treatment with TNFi 37 regardless of the amount of pain relief. 26 Our recent brain imaging investigation of the central mechanism of fatigue in AS indicates that pain and fatigue have differential effects on the brain; fatigue more strongly impacting motor and attentional networks 40 than areas more classically implicated in pain perception. 7 The aim of this study was to examine the differential effect of TNFi treatment on symptom relief in patients with AS with focus on pain and fatigue.…”

Response to peripheral immune stimulation within the brain: magnetic resonance imaging perspective of treatment success

“…The cytokines alter the metabolism of neurotransmitters serotonin [ 27 , 28 ], dopamine [ 28 – 31 ], glutamate [ 32 , 33 ], which in turn leads to decreased production of the trophic or growth factors necessary for neurogenesis and neuroplasticity [ 6 , 34 , 35 ], or norepinephrine [ 5 , 6 ]. Many studies demonstrated reduction of brain matter, especially in hippocampus [ 19 , 35 – 37 ], but also different alterations in other areas of the brain [ 38 – 43 ] under continuously elevated IL, or changes in functional connectivity [ 43 – 48 ]. The latter can best be encompassed by functional neuroimaging methods and will be discussed in a separate section.…”