Open AccessAssociation of brain functional magnetic resonance activity with response to tumor necrosis factor inhibition in rheumatoid arthritis
Author(s) -
Rech Juergen,
Hess Andreas,
Finzel Stephanie,
Kreitz Silke,
Sergeeva Marina,
Englbrecht Matthias,
Doerfler Arnd,
Saake Marc,
Schett Georg
Publication year - 2013
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.37761
Subject(s) - medicine , rheumatoid arthritis , magnetic resonance imaging , functional magnetic resonance imaging , disease , tumor necrosis factor alpha , brain activity and meditation , radiology , electroencephalography , psychiatry
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). Conclusion These data suggest that response to TNFi depends on brain activity in RA patients, reflecting the subjective perception of disease.