title: Association of brain functional magnetic resonance activity with response to tumor necrosis factor inhibition in rheumatoid arthritis.
abstract: OBJECTIVE
  To test whether brain activity predicts the response to tumor necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA). Since clinical and laboratory parameters have proven unsuccessful in predicting response, we followed a radically different concept, hypothesizing that response to TNFi depends on central nervous system activity rather than the clinical signs of disease.
  
  
  METHODS
  Sequential testing by functional magnetic resonance imaging (MRI) of the brain, anatomic MRI of the hand, and clinical assessment of arthritis were carried out in 10 patients with active RA before and 3, 7, and 28 days after the start of TNFi treatment.
  
  
  RESULTS
  Baseline demographic and disease-specific parameters were identical in TNFi responders and nonresponders. The mean ± SEM decrease in the Disease Activity Score in 28 joints after 28 days was -1.8 ± 0.3 in TNFi responders (n = 5) and -0.2 ± 0.1 in nonresponders (n = 5). Responders showed significantly higher baseline activation in thalamic, limbic, and associative areas of the brain than nonresponders. Moreover, brain activity decreased within 3 days after TNFi exposure in the responders, preceding clinical responses (day 7) and responses observed on the anatomic hand MRI (day 28).
  
  
  CONCLUSIONS
  These data suggest that response to TNFi depends on brain activity in RA patients, reflecting the subjective perception of disease.
authors.affiliation: University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Rech
authors.forename: Andreas
authors.initials: A
authors.lastname: Hess
authors.forename: Stephanie
authors.initials: S
authors.lastname: Finzel
authors.forename: Silke
authors.initials: S
authors.lastname: Kreitz
authors.forename: Marina
authors.initials: M
authors.lastname: Sergeeva
authors.forename: Matthias
authors.initials: M
authors.lastname: Englbrecht
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Marc
authors.initials: M
authors.lastname: Saake
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007596:Joints / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate