title: Disease activity and cognition in rheumatoid arthritis: an open label pilot study.
abstract: BACKGROUND
  We 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Patients 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.
  
  
  CONCLUSIONS
  We 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.
authors.forename: Graham
authors.initials: G
authors.lastname: Raftery
authors.forename: Jiabao
authors.initials: J
authors.lastname: He
authors.forename: Ruth
authors.initials: R
authors.lastname: Pearce
authors.forename: Daniel
authors.initials: D
authors.lastname: Birchall
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Blamire
authors.forename: John D
authors.initials: JD
authors.lastname: Isaacs
mesh_terms: D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D003071:Cognition / Q000187:drug effects* / Q000502:physiology; D005221:Fatigue / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care / Q000379:methods; D010865:Pilot Projects; D011594:Psychometrics; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D064232:Visual Analog Scale; D014888:Wechsler Scales
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab