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Disease activity and cognition in rheumatoid arthritis: an open label pilot study

Lookup NU author(s): Dr Daniel Birchall, Emerita Professor Julia Newton, Professor Andrew BlamireORCiD, Professor John IsaacsORCiD



Introduction: We hypothesised that fatigue in rheumatoid arthritis (RA) is related to TNF-alpha induced dysregulation of cerebral blood flow. Our objectives were to assess fatigue, cognitive function and cerebral blood flow before and after initiation of anti-TNF treatment. Methods: In a pilot study, 15 patients initiating treatment with adalimumab were assessed for fatigue using a visual analogue scale (FACIT-F), cognitive function using a panel of psychometric tests and regional cerebral blood flow using MR perfusion imaging. Results: Patients improved clinically after anti-TNF therapy in terms of DAS28 and FACIT-F. Furthermore significant improvements were documented in full scale, verbal and performance IQ following therapy. There was a nonsignificant trend towards reduced cerebral perfusion in both grey and white matter, and fatigue at 3 months correlated with cerebral blood flow in white (p = 0.014) and grey (p = 0.005) matter. Conclusions: We demonstrate for the first time a significant improvement in cognitive function following effective treatment of RA. Although we observed minor reductions in cerebral blood flow, and a correlation between cerebral blood flow and fatigue, a larger, controlled study would be required to affirm a causal relationship.

Publication metadata

Author(s): Raftery G, He JB, Pearce R, Birchall D, Newton JL, Blamire AM, Isaacs JD

Publication type: Article

Publication status: Published

Journal: Arthritis Research & Therapy

Year: 2012

Volume: 14

Issue: 6

Print publication date: 04/12/2012

Date deposited: 26/03/2013

ISSN (electronic): 1478-6354

Publisher: BioMed Central Ltd.


DOI: 10.1186/ar4108


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