Nav: Home

How the brain plays a role in rheumatoid arthritis inflammation

June 18, 2018

ANN ARBOR, Mich. - In patients with chronic inflammatory conditions, such as rheumatoid arthritis, there has been limited understanding of how this inflammation affects the brain.

A new study published in Nature Communications examines this issue.

"Rheumatoid arthritis is an inflammatory and autoimmune condition with nasty levels of inflammation that can affect a person's joints and the rest of their body, inducing fatigue, sleep and creating cognitive difficulties," says Andrew Schrepf, Ph.D., a research investigator at Michigan Medicine's Chronic Pain and Fatigue Research Center and one of the lead authors of the study.

"Even though it has been assumed for a long time that the inflammation we see in blood is impacting the brain, up until this study we didn't know precisely where and how those changes in the brain were actually happening."

Schrepf says the effects of inflammation are more understood in short-term illnesses, but the same can't be said for chronic conditions.

"When a person becomes sick with the flu, for example, they begin to show symptoms of the inflammation happening in their body, such as feeling lethargic and being unable to control their body temperature," he says. "We wanted to understand what is happening in conditions where patients have inflammation for weeks, months or years, such as in rheumatoid arthritis."

A "remarkable" data set

The research team used a data set of 54 rheumatoid arthritis patients carefully constructed and characterized by author Neil Basu, Ph.D., of the University of Aberdeen in the United Kingdom, Schrepf says.

"Studies such as ours are usually performed in healthy people who are induced with sickness behaviors," Schrepf explains, calling the available data "remarkable." "They will then do a brain scan before and after the immune insult, and the results are interesting, but to understand how it impacts people with chronic illness, we have to see the brain of someone with inflammation happening for a long period of time."

Using functional and structural neuroimaging of the data set at baseline and six months, the research team examined whether higher levels of peripheral inflammation were associated with brain connectivity and structure.

"We took the levels of inflammation in their peripheral blood, just as it would be done clinically by a rheumatologist to monitor the severity of their disease and how it's being controlled," Schrepf says. "We found profound and consistent results in a couple areas of the brain that were becoming connected to several brain networks. We then looked again six months later and saw similar patterns, and this replication of results is not that common in neuroimaging studies."

Co-first author Chelsea Kaplan, Ph.D., an anesthesiology research fellow at Michigan Medicine, then examined the functional connectivity of 264 regions of the brain and identified increased connectivity patterns in patients experiencing heightened levels of inflammation.

"In a graph theoretical analysis across the whole brain network, and correlating that with levels of inflammation, we saw a lot of convergence across methods and time points for the amount of connectivity in the inferior parietal lobule and medial prefrontal cortex," Kaplan says.

"This showed us that the brain doesn't operate in isolation. It also demonstrated how inflammation we measure in the periphery may be actually altering functional connections in the brain and playing a role in some of the cognitive symptoms we see in rheumatoid arthritis."

Applying the results in the clinical setting

Basu, who is a practicing rheumatologist and a researcher, notes anti-inflammatory therapeutics have evolved over the past decade and have alleviated the peripheral inflammation driving the joint pain and disability in rheumatoid arthritis. Despite such progress, patients continue to report challenging levels of symptoms such as fatigue and mood dysfunction.

"This intriguing data supports the idea that rheumatoid arthritis inflammation targets the brain and not just the joints," Basu says. "By relating these advanced neuroimaging measures back to the patient experience, we provide evidence that the future targeting of central inflammatory pathways may greatly enhance the quality of life of patients with rheumatoid arthritis and potentially other chronic inflammatory disorders."

Because this is one of the first studies to examine brain inflammation in rheumatoid arthritis, Schrepf says, additional research is needed on the correlation.

Basu agrees, "Further exploration into this complex space demands strong multidisciplinary and collaborative working, and this study represents a fine example of trans-Atlantic team science."
-end-


Michigan Medicine - University of Michigan

Related Rheumatoid Arthritis Articles:

Study examines opioid use in patients with rheumatoid arthritis
A new analysis indicates that the use of opioid pain medications in older US rheumatoid arthritis patients peaked in 2010 and is now declining slightly.
Studies examine rheumatoid arthritis patients' prognosis
What's the long-term outlook for today's patients with early rheumatoid arthritis?
Obesity may influence rheumatoid arthritis blood tests
New research reveals that in women, obesity may influence blood tests used to diagnose and monitor rheumatoid arthritis.
New tool for prognosis and choice of therapy for rheumatoid arthritis
In rheumatoid arthritis, antibodies are formed that affect the inflammation in the joints.
The promise of precision medicine for rheumatoid arthritis
In a new study, a Yale-led research team identified the mechanism of a gene that raises the risk of severe rheumatoid arthritis in susceptible individuals.
Immunotherapy reduces cardiovascular risk in rheumatoid arthritis
Weight loss from bariatric surgery appears to reverse the premature aging associated with obesity, according to research presented today at Frontiers in CardioVascular Biology 2016.
Osteoarthritis just as severe as rheumatoid arthritis
Rheumatologists more likely to underestimate clinical status of their OA patients than their RA patients
Serotonin deficiency implicated in rheumatoid arthritis
For the first time, serotonin (5-hydroxytryptamine, 5-HT) has been directly implicated in the pathophysiology of rheumatoid arthritis (RA).
Link between mood, pain in rheumatoid arthritis patients
Depressive symptoms and mood in the moment may predict momentary pain among rheumatoid arthritis patients, according to Penn State researchers.
Inflammation in the mouth and joints in rheumatoid arthritis
Today at the 93rd General Session and Exhibition of the International Association for Dental Research, researcher Sheila Arvikar, Massachusetts General Hospital, Boston, USA, will present a study titled 'Inflammation in the Mouth and Joints in Rheumatoid Arthritis.' The IADR General Session is being held in conjunction with the 44th Annual Meeting of the American Association for Dental Research and the 39th Annual Meeting of the Canadian Association for Dental Research.

Related Rheumatoid Arthritis Reading:

The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases
by Amy Myers M.D. (Author)

Living with Rheumatoid Arthritis (A Johns Hopkins Press Health Book)
by Tammi L. Shlotzhauer MD (Author)

The Rheumatoid Arthritis Cookbook: Anti-Inflammatory Recipes to Fight Flares and Fatigue
by Caitlin Samson MSACN (Author)

The Immune System Recovery Plan: A Doctor's 4-Step Program to Treat Autoimmune Disease
by Susan Blum (Author), Mark Hyman (Foreword), Michele Bender (Foreword)

The First Year: Rheumatoid Arthritis: An Essential Guide for the Newly Diagnosed
by M.E.A. McNeil (Author), Kenneth Sack (Foreword)

Stuff you should know about Rheumatoid Arthritis
by Dr Irwin Lim (Author)

Rheumatoid Arthritis Diet: The Simple Anti-Inflammatory Diet For A Healthy Immune System - 4 STEP PLAN TO FIGHT RHEUMATOID ARTHRITIS
by Ross Lennox (Author)

Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain
by Lene Andersen (Author)

Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease
by Kelly O'Neill Young (Author)

Healing Arthritis: Your 3-Step Guide to Conquering Arthritis Naturally
by Susan Blum MD MPH (Author), Mark Hyman M.D. (Foreword), Michele Bender (Foreword)

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".