Brain involvement in rheumatoid arthritis: a magnetic resonance spectroscopy study.
OBJECTIVE
Tumor necrosis factor alpha 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.


CONCLUSIONS
Our data show that systemic inflammation in RA is associated with metabolic changes in the brain.
Emmer
Bart J
BJ
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. b.j.emmer@lumc.nl
van der Bijl
A Egon
AE
Huizinga
Tom W J
TW
Breedveld
Ferdinand C
FC
Steens
Stefan C A
SC
Th Bosma
Gerlof P
GP
van Buchem
Mark A
MA
van der Grond
Jeroen
J
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001799:Blood Sedimentation; D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D016022:Case-Control Studies; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline