Researchers from the University of Michigan and University of Aberdeen in the UK used functional and structural magnetic resonance imaging (MRI) to examine whether higher levels of peripheral inflammation were associated with brain connectivity and structure in 54 rheumatoid arthritis (RA) patients.
Joint Inflammation Linked to Cognitive Decline?
2 min read Premium comments
#rheumatoidarthritisSecondary#inflammation#cognitivedamage
Their work, “A multi-modal MRI study of the central response to inflammation in rheumatoid arthritis,” was published in the June 8, 2018 edition of Nature Communications.
Co-author Andrew Schrepf, Ph.D., a research investigator in the department of Anesthesiology and the Chronic Pain and Fatigue Research Center at the University of Michigan Health System, told OTW, “There have been so many signs pointing in the direction of inflammation having a big role to play in the brains of people with chronic conditions. There have been really high-quality studies using animal models and a lot of creative clinical research, but we were not able to find much at all where inflammatory measures were combined with neuroimaging in a chronic inflammatory condition like RA.”
“I think we see very clearly that a couple of brain regions respond strongly to the presence of inflammation—the inferior parietal lobule and part of the prefrontal cortex.”
“It was very interesting to see that the pattern was for these to become more functionally connected to established neural networks.”
“In some studies with healthy people it looks more like connections become weaker when a person’s immune system is challenged, say with a vaccine or fragments of a bacteria. What we think we might be seeing is the brain compensating for an inflammatory insult that has been going on a long time as is often the case in RA.”
“I think is important to know that controlling inflammation effectively may have a lot of benefit for the central nervous system in these patients. We found some patterns of structural deficits in the brain associated with high inflammation—it could be that effective treatment will actually spare gray matter in the brain over the long term, though we need more research to be sure about that.”
“A good number of patients with osteoarthritis (OA) have levels of inflammation in blood that are higher than healthy people. It is very possible that some of more systemic symptoms in OA are related to a similar phenomenon we observed in RA occurring at a lower level. We can only speculate right now, but the work is ongoing.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.