MRI brain findings in Rheumatoid Arthritis: a review of the literature

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder that mainly attacks the joints and leads to early disability. Despite aggressive anti-inflammatory therapy, the risk of systemic complications remains high. Moreover, the rate of premature cardiovascular disease mortality in patients with active RA, as well as the risk for development of non-fatal cardiovascular and cerebrovascular complications is also high. Central nervous system (CNS) involvement is one of the main components of extra-articular manifestations of RA. Brain changes might be caused by systemic inflammatory response or by the drugs used for treatment. Assessment of brain involvement and its relationship to the characteristics of the disease in patients with RA are particularly useful. Early detection of changes without cerebral symptoms and rapid response in acute events are of particular importance. With the increasing use of more imaging modalities magnetic resonance imaging (MRI) has become highly specific, safe and non-invasive diagnostic tool for early detection and monitoring of different pathological processes involving the brain in patients with RA. Understanding MRI imaging findings in brain involvement is important for selecting appropriate treatment and control of disease progression. The aim of this review is to summarize literature data of brain changes in RA and their relationship with systemic inflammation as well as to demonstrate the role of MRI in their assessment.