1
|
Liu Z, Hou B, You H, Yu C, Tian X, Li M, Zeng X, Wang Q, Feng F. Microstructural abnormality of white matter tracts in rheumatoid arthritis. Brain Res 2024; 1832:148862. [PMID: 38471645 DOI: 10.1016/j.brainres.2024.148862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Structural and functional brain imaging studies have reported abnormalities of gray matter morphology and functional activities in patients with rheumatoid arthritis (RA). However, it is largely unknown whether patients with RA show alterations of white matter microstructural organization. OBJECTIVES To automatically identify alteration of white matter microstructure in patients with RA and further examine how this alteration associates with clinical characteristics. METHODS This single-institutional prospective study included 66 participants (33 patients with RA [52 ± 9 years, 29 women] and 33 sex/age-matched healthy controls [53 ± 12 years, 27 women]), who underwent diffusion MRI scan from January 2021 to December 2021. The white matter microstructure was assessed using fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. Voxelwise analyses were conducted on white matter skeleton using an automated, observer-independent tract-based spatial statistics analysis. The relationship between white matter microstructural alterations and clinical and neuropsychological variables was evaluated using correlation analysis. RESULTS Compared with healthy controls, patients with RA exhibited lower fractional anisotropy in several major white matter tracts (threshold-free cluster enhancement at P < 0.05 for multiple comparison correction, permutation test), involving the forceps minor, bilateral inferior fronto-occipital fasciculus, bilateral anterior thalamic radiation, and bilateral uncinate fasciculus. Lower fractional anisotropy values in the patients with RA were significantly associated with pain-related assessments, including tender joint count (r = -0.43, P = 0.015), Clinical Disease Activity Index score (r = -0.36, P = 0.049), pain severity rated through visual analogue scale (r = -0.45, P = 0.012), and Simplified Disease Activity Index score (r = -0.36, P = 0.045). No significant group difference was found in mean diffusivity, axial diffusivity, and radial diffusivity. CONCLUSIONS We report the first anatomical evidence for aberrant microstructure organization of several major white matter tracts and its associations with pain processing in patients with rheumatoid arthritis.
Collapse
Affiliation(s)
- Zeyu Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chen Yu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| |
Collapse
|
2
|
Sofat N, Lambarth A. Can we achieve pain stratification in musculoskeletal conditions? Implications for clinical practice. FRONTIERS IN PAIN RESEARCH 2024; 5:1362757. [PMID: 38524267 PMCID: PMC10958789 DOI: 10.3389/fpain.2024.1362757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
In the last few years there has been an increased appreciation that pain perception in rheumatic and musculoskeletal diseases (RMDs) has several mechanisms which include nociceptive, inflammatory, nociplastic and neuropathic components. Studies in specific patient groups have also demonstrated that the pain experienced by people with specific diagnoses can present with distinctive components over time. For example, the pain observed in rheumatoid arthritis has been widely accepted to be caused by the activation of nociceptors, potentiated by the release of inflammatory mediators, including prostaglandins, leukotrienes and cytokine networks in the joint environment. However, people with RA may also experience nociplastic and neuropathic pain components, particularly when treatments with disease modifying anti-rheumatic drugs (DMARDs) have been implemented and are insufficient to control pain symptoms. In other RMDs, the concept of pain sensitisation or nociplastic pain in driving ongoing pain symptoms e.g. osteoarthritis and fibromyalgia, is becoming increasingly recognised. In this review, we explore the hypothesis that pain has distinct modalities based on clinical, pathophysiological, imaging and genetic factors. The concept of pain stratification in RMD is explored and implications for future management are also discussed.
Collapse
Affiliation(s)
- Nidhi Sofat
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew Lambarth
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
3
|
Minhas D. Pain mechanisms for the practicing rheumatologist. Best Pract Res Clin Rheumatol 2024; 38:101942. [PMID: 38521633 DOI: 10.1016/j.berh.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
Pain in rheumatic diseases transcends the traditional nociceptive paradigm, incorporating complex interactions between nociceptive, neuropathic, and nociplastic mechanisms, as well as significant psychosocial factors. Advances in understanding chronic pain highlight the role of peripheral and central sensitization, and the emergence of nociplastic pain-a result of altered central nervous system processing. This modern perspective acknowledges the influence of mood disorders, environmental stressors, and cognitive patterns like catastrophizing, revealing the intricate interplay between biological, psychological, and social determinants of pain. Research emphasizes the brain's pivotal role in pain perception, underscoring the importance of comprehensive approaches that integrate medical, psychological, and social interventions to address the multifaceted nature of chronic pain in rheumatic diseases effectively.
Collapse
Affiliation(s)
- Deeba Minhas
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
| |
Collapse
|
4
|
Yang HJ, Wu HM, Li XH, Jin R, Zhang L, Dong T, Zhou XQ, Zhang B, Zhang QJ, Mao CP. Functional disruptions of the brain network in low back pain: a graph-theoretical study. Neuroradiology 2023; 65:1483-1495. [PMID: 37608218 DOI: 10.1007/s00234-023-03209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The aim of this study was to investigate alterations in the topological organization of whole-brain functional networks in patients with chronic low back pain (CLBP) and characterize the relationship of these alterations with pain characteristics. METHODS Thirty-three CLBP patients and 34 matched healthy controls (HCs) underwent fMRI scans. A graph-theoretical approach was applied to identify brain network changes in patients suffering from chronic low back pain given its nonspecific etiology and complexity. Graph theory-based analysis was used to construct functional connectivity matrices and extract the features of small-world networks of the brain in both groups. Then, the whole-brain functional connectivity differences were characterized by network-based statistics (NBS) analysis, and the relationship between the altered brain features and clinical measures was explored. RESULTS At the global level, patients with CLBP showed significantly decreased gamma, sigma, global efficiency, and local efficiency and increased lambda and shortest path length compared with HCs. At the regional level, there were deficits in nodal efficiency within the default mode network and salience network. NBS analysis demonstrated that decreased functional connectivity was present in the CLBP patients, mainly in the frontolimbic circuit and temporal regions. Furthermore, aspects of topological dysfunctions in CLBP were correlated with pain severity. CONCLUSION This study highlighted the aberrant topological organization of functional brain networks in CLBP, which may shed light on the pathophysiology of CLBP and support the development of pain management approaches.
Collapse
Affiliation(s)
- Hua Juan Yang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Hong Mei Wu
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Hui Li
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Rui Jin
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Lei Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Ting Dong
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Xiao Qian Zhou
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Bo Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Qiu Juan Zhang
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
| | - Cui Ping Mao
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, 157, Xi'wu Road, Xi'an, 710004, Shaanxi, China.
| |
Collapse
|
5
|
Taylor PC. Pain in the joints and beyond; the challenge of rheumatoid arthritis. THE LANCET. RHEUMATOLOGY 2023; 5:e351-e360. [PMID: 38251602 DOI: 10.1016/s2665-9913(23)00094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 01/23/2024]
Abstract
Pain is a common and often debilitating symptom for people living with rheumatoid arthritis. Although pain is a generic feature of inflammation and often improves with successful treatment that targets inflammatory pathways, pain experience can persist. Emerging data suggest that the magnitude of pain relief might vary according to the therapeutic target of pharmacological intervention within the inflammatory cascade. Both inflammatory and non-inflammatory causes contribute to the pain experience, which depends on tissue origin, peripheral sensory mechanisms and their transmission, integration, and interpretation within the nervous system. Contemporary neuroimaging is transforming our understanding of these mechanisms and the role of sensory, emotional, and cognitive contributions to the experience of pain. This understanding paves the way for therapeutic approaches that recognise the existence of multiple, cognitively driven, supraspinal mechanisms for pain modulation and could complement pharmacological inflammation suppression. Such approaches include neuropsychological interventions that have the potential to modify human brain cortical structure and reduce suffering that is often associated with pain experience.
Collapse
Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| |
Collapse
|
6
|
Allen HN, Chaudhry S, Hong VM, Lewter LA, Sinha GP, Carrasquillo Y, Taylor BK, Kolber BJ. A Parabrachial-to-Amygdala Circuit That Determines Hemispheric Lateralization of Somatosensory Processing. Biol Psychiatry 2023; 93:370-381. [PMID: 36473754 PMCID: PMC9852076 DOI: 10.1016/j.biopsych.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The central amygdala (CeA) is a bilateral hub of pain and emotional processing with well-established functional lateralization. We reported that optogenetic manipulation of neural activity in the left and right CeA has opposing effects on bladder pain. METHODS To determine the influence of calcitonin gene-related peptide (CGRP) signaling from the parabrachial nucleus on this diametrically opposed lateralization, we administered CGRP and evaluated the activity of CeA neurons in acute brain slices as well as the behavioral signs of bladder pain in the mouse. RESULTS We found that CGRP increased firing in both the right and left CeA neurons. Furthermore, we found that CGRP administration in the right CeA increased behavioral signs of bladder pain and decreased bladder pain-like behavior when administered in the left CeA. CONCLUSIONS These studies reveal a parabrachial-to-amygdala circuit driven by opposing actions of CGRP that determines hemispheric lateralization of visceral pain.
Collapse
Affiliation(s)
- Heather N Allen
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania; Department of Neuroscience and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas; Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Chaudhry
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Veronica M Hong
- Department of Neuroscience and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas
| | - Lakeisha A Lewter
- Department of Neuroscience and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas
| | - Ghanshyam P Sinha
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yarimar Carrasquillo
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Bradley K Taylor
- Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benedict J Kolber
- Department of Neuroscience and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas.
| |
Collapse
|
7
|
Cox JG, de Groot M, Cole JH, Williams SCR, Kempton MJ. A meta-analysis of structural MRI studies of the brain in systemic lupus erythematosus (SLE). Clin Rheumatol 2023; 42:319-326. [PMID: 36534349 PMCID: PMC9873736 DOI: 10.1007/s10067-022-06482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
A comprehensive search of published literature in brain volumetry was conducted in three autoimmune diseases - systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ulcerative colitis (UC) - with the intention of performing a meta-analysis of published data. Due to the lack of data in RA and UC, the reported meta-analysis was limited to SLE. The MEDLINE database was searched for studies from 1988 to March 2022. A total of 175 papers met the initial inclusion criteria, and 16 were included in a random-effects meta-analysis. The reduction in the number of papers included in the final analysis is primarily due to the lack of overlap in measured and reported brain regions. A significantly lower volume was seen in patients with SLE in the hippocampus, corpus callosum, and total gray matter volume measurements as compared to age- and sex-matched controls. There were not enough studies to perform a meta-analysis for RA and UC; instead, we include a summary of published volumetric studies. The meta-analyses revealed structural brain abnormalities in patients with SLE, suggesting that lower global brain volumes are associated with disease status. This volumetric difference was seen in both the hippocampus and corpus callosum and total gray matter volume measurements. These results indicate both gray and white matter involvements in SLE and suggest there may be both localized and global reductions in brain volume.
Collapse
Affiliation(s)
- Jennifer G Cox
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Steven C R Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
8
|
Lada G, Talbot PS, Chinoy H, Warren RB, McFarquhar M, Kleyn CE. Brain structure and connectivity in psoriasis and associations with depression and inflammation; findings from the UK biobank. Brain Behav Immun Health 2022; 26:100565. [PMID: 36471870 PMCID: PMC9719019 DOI: 10.1016/j.bbih.2022.100565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/02/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Psoriasis is a chronic systemic inflammatory skin disease, coexisting with depression in up to 25% of patients. Little is known about the drivers of comorbidity, including shared neurobiology and depression brain imaging patterns in patients. An immune-mediated crosstalk between the brain and skin has been hypothesized in psoriasis. With the aim of investigating brain structure and connectivity in psoriasis in relation to depression comorbidity, we conducted a brain imaging study including the largest psoriasis patient sample to date (to our knowledge) and the first to investigate the role of depression and systemic inflammation in brain measures. Effects of coexisting psoriatic arthritis (PsA), which represents joint involvement in psoriasis and a higher putative inflammatory state, were further explored. Methods Brain magnetic resonance imaging (MRI) data of 1,048 UK Biobank participants were used (131 comorbid patients with psoriasis and depression, age-and sex-matched to: 131 non-depressed psoriasis patients; 393 depressed controls; and 393 non-depressed controls). Interaction effects of psoriasis and depression on volume, thickness and surface of a-priori defined regions of interest (ROIs), white matter tracts and 55x55 partial correlation resting-state connectivity matrices were investigated using general linear models. Linear regression was employed to test associations of brain measures with C-reactive protein (CRP) and neutrophil counts. Results No differences in regional or global brain volumes or white matter integrity were found in patients with psoriasis compared to controls without psoriasis or PsA. Thickness in right precuneus was increased in psoriasis patients compared to controls, only when depression was present (β = 0.26, 95% CI [Confidence Intervals] 0.08, 0.44; p = 0.02). In further analysis, psoriasis patients who had PsA exhibited fronto-occipital decoupling in resting-state connectivity compared to patients without joint involvement (β = 0.39, 95% CI 0.13, 0.64; p = 0.005) and controls (β = 0.49, 95% CI 0.25, 0.74; p < 0.001), which was unrelated to depression comorbidity. Precuneus thickness and fronto-occipital connectivity were not predicted by CRP or neutrophil counts. Precuneus thickening among depressed psoriasis patients showed a marginal correlation with recurrent lifetime suicidality. Conclusions Our findings provide evidence for a combined effect of psoriasis and depression on the precuneus, which is not directly linked to systemic inflammation, and may relate to suicidality or altered somatosensory processing. The use of the UK Biobank may limit generalizability of results in populations with severe disease.
Collapse
Affiliation(s)
- Georgia Lada
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, M13 9PL, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Peter S. Talbot
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, M13 9PL, UK
| | - Richard B. Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Martyn McFarquhar
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - C. Elise Kleyn
- Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
9
|
Phukan P, Barman B, Chengappa NK, Lynser D, Paul S, Nune A, Sarma K. Diffusion tensor imaging analysis of rheumatoid arthritis patients with neuropsychiatric features to determine the alteration of white matter integrity due to vascular events. Clin Rheumatol 2022; 41:3169-3177. [PMID: 35751734 DOI: 10.1007/s10067-022-06262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The pathophysiology of neuropsychiatric manifestations in rheumatoid arthritis is not well known. The magnetic resonance imaging of the brain in rheumatoid arthritis demonstrates non-specific findings, and in the majority of cases, magnetic resonance imaging fails to detect an abnormality, even in rheumatoid arthritis patients with neuropsychiatric manifestations. Therefore, we aimed to assess microstructural integrity changes of white matter in patients with rheumatoid arthritis by using different diffusion tensor imaging parameters. METHODS Eighteen rheumatoid arthritis patients (10 with neuropsychiatric symptoms and 8 without any neuropsychiatric symptoms) and 14 controls were included. The volume of the T2 hyperintense lesions was assessed. Different diffusion tensor imaging parameters such as fractional anisotropy, apparent diffusion coefficient, trace, axial diffusivity, and radial diffusivity were obtained from six different regions of white matter. Inter group significant difference was determined by one-way analysis of variance followed by Tukey's post hoc test. The accuracy of diffusion tensor imaging matrices was evaluated from the receiver operating characteristic curve. RESULTS No significant difference in lesions' volume was detected between rheumatoid arthritis patients with or without neuropsychiatric symptoms. There was an increased apparent diffusion coefficient and radial diffusivity (p < 0.05) as well as decreased fractional anisotropy and axial diffusivity (p < 0.5) in rheumatoid arthritis patients with neuropsychiatric symptoms compared to controls. Moreover, the apparent diffusion coefficient (p < .05) was increased in both positive and negative MRI of patients with neuropsychiatric features compared to the control group. The sensitivity and specificity of the apparent diffusion coefficient parameters was 73% and 72%, respectively. CONCLUSIONS The various anisotropic metrics were altered in rheumatoid arthritis patients with neuropsychiatric symptoms by using diffusion tensor imaging analysis, representing that central nervous system vasculitis leads to tissue hypoxia resulting in vasogenic edema. This may lead to axonal and myelin degeneration of white matter fibers and neuronal cell disruption. Key Points • Our study confirms that neurovascular events are not uncommon in RA patients with NP features. Diffusion tensor imaging (DTI) is superior to conventional MRI scan for RA patients with NP features because it distinguishes between gray and white matter structures. • RA patients with NP features are more likely to have microstructural changes detected by DTI than by DWI, and it can provide comprehensive anatomical layouts describing regional disparities in neurodegeneration. • DTI's quantitative association of NP symptoms in a large patient cohort is an important study scope.
Collapse
Affiliation(s)
- Pranjal Phukan
- Department of Radiology & Imaging, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, 793018, India
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, 793018, India.
| | - Nivedita Kharkongor Chengappa
- Department of Pediatrics, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, 793018, India
| | - Donboklang Lynser
- Department of Radiology & Imaging, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, 793018, India
| | - Subhraneel Paul
- Department of Radiology & Imaging, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, 793018, India
| | - Arvind Nune
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Kalyan Sarma
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Wei X, Shi G, Tu J, Zhou H, Duan Y, Lee CK, Wang X, Liu C. Structural and Functional Asymmetry in Precentral and Postcentral Gyrus in Patients With Unilateral Chronic Shoulder Pain. Front Neurol 2022; 13:792695. [PMID: 35250808 PMCID: PMC8892006 DOI: 10.3389/fneur.2022.792695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to explore the structural and functional asymmetry of precentral and postcentral gyrus in patients with unilateral chronic shoulder pain (CSP) utilizing MRI. Patients and Methods We collected structural and resting-state functional MRI (rs-fMRI) data in 22 left-sided, 15 patients with right-sided CSP, and 24 healthy controls (HCs). Here, we performed the structural asymmetry and seed-based functional connectivity (FC) analyses. We extracted regional cortical thickness and surface area measurements from T1-weighted MRI images, using asymmetry indexes (AIs) to assess asymmetries. We used Data Processing and Analysis for Brain Imaging software for seed-based FC analysis and selected unilateral-precentral and postcentral as the regions of interest. Then, we performed group comparisons of the neuroimaging metrics, and also explored the relationships between brain asymmetry and clinical variables. Results We found significant differences in surface area AIs of the precentral among three groups, the AI values were negatively correlated with the visual analog scale score and positively correlated with Constant–Murley scores (CMS) in the left-sided CSP group. Further, FC of left postcentral with cingulate gyrus and left paracentral lobule showed significant group differences; FC of right postcentral with left caudate, left paracentral, and left postcentral were different among groups; FC of right precentral with the cingulate gyrus, precuneus, and left paracentral revealed significant group differences. Besides, there was a positive correlation between right precentral-cingulate gyrus FC and CMS in the right-sided CSP group. Conclusion Surface area and FC patterns asymmetry exist in precentral and postcentral gyrus in patients with unilateral CSP. Asymmetry trend is associated with pain severity and shoulder joint function impairment. Brain structural and functional asymmetry may be an important indicator for understanding the potential mechanism of chronic pain.
Collapse
Affiliation(s)
- Xiaoya Wei
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jianfeng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hang Zhou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yanshan Duan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chin Kai Lee
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- Xu Wang
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Cunzhi Liu
| |
Collapse
|
11
|
Danilin LK, Spindler M, Sörös P, Bantel C. Heart rate and heart rate variability in patients with chronic inflammatory joint disease: the role of pain duration and the insular cortex. BMC Musculoskelet Disord 2022; 23:75. [PMID: 35062938 PMCID: PMC8783425 DOI: 10.1186/s12891-022-05009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Chronic inflammatory joint diseases (CIJD) have been linked to increased cardiovascular morbidity and mortality. A decisive reason could be a dysregulation of the autonomic nervous system, which is responsible for the control of cardiovascular function. So far, the cause of changes in autonomic nervous system functions remains elusive. In this study, we investigate the role of chronic pain and the insular cortex in autonomic control of cardiac functioning in patients with CIJD.
Methods
We studied the autonomic nervous system through the assessment of heart rate and heart rate variability (HRV) at rest and under cognitive stimulation. Furthermore, we investigated insular cortex volume by performing surface-based brain morphometry with FreeSurfer. For this study, 47 participants were recruited, 22 individual age- and sex-matched pairs for the magnetic resonance imaging analyses and 14 for the HRV analyses. All available patients’ data were used for analysis.
Results
Pain duration was negatively correlated with the resting heart rate in patients with chronic inflammatory joint diseases (n = 20). In a multiple linear regression model including only CIJD patients with heart rate at rest as a dependent variable, we found a significant positive relationship between heart rate at rest and the volume of the left insular cortex and a significant negative relationship between heart rate at rest and the volume of the right insular cortex. However, we found no significant differences in HRV parameters or insular cortex volumes between both groups.
Conclusions
In this study we provide evidence to suggest insular cortex involvement in the process of ANS changes due to chronic pain in CIJD patients.
The study was preregistered with the German Clinical Trials Register (https://www.drks.de; DRKS00012791; date of registration: 28 July 2017).
Collapse
|
12
|
Upadhyay J, Lemme J, Cay M, Van Der Heijden H, Sibai D, Goodlett B, Lo J, Hoyt K, Taylor M, Hazen MM, Halyabar O, Meidan E, Schreiber R, Chang MH, Nigrovic PA, Jaimes C, Henderson LA, Ecklund K, Sundel RP. A multidisciplinary assessment of pain in juvenile idiopathic arthritis. Semin Arthritis Rheum 2021; 51:700-711. [PMID: 34139523 PMCID: PMC9741862 DOI: 10.1016/j.semarthrit.2021.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pain is prevalent in juvenile idiopathic arthritis (JIA). Unknowns regarding the biological drivers of pain complicate therapeutic targeting. We employed neuroimaging to define pain-related neurobiological features altered in JIA. METHODS 16 male and female JIA patients (12.7 ± 2.8 years of age) on active treatment were enrolled, together with age- and sex-matched controls. Patients were assessed using physical examination, clinical questionnaires, musculoskeletal MRI, and structural neuroimaging. In addition, functional magnetic resonance imaging (fMRI) data were collected during the resting-state, hand-motor task performance, and cold stimulation of the hand and knee. RESULTS Patients with and without pain and with and without inflammation (joint and systemic) were evaluated. Pain severity was associated with more physical stress and poorer cognitive function. Corrected for multiple comparisons, morphological analysis revealed decreased cortical thickness within the insula cortex and a negative correlation between caudate nucleus volume and pain severity. Functional neuroimaging findings suggested alteration within neurocircuitry structures regulating emotional pain processing (anterior insula) in addition to the default-mode and sensorimotor networks. CONCLUSIONS Patients with JIA may exhibit changes in neurobiological circuits related to pain. These preliminary findings suggest mechanisms by which pain could potentially become dissociated from detectable joint pathology and persist independently of inflammation or treatment status.
Collapse
Affiliation(s)
- Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
| | - Jordan Lemme
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariesa Cay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Hanne Van Der Heijden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, the Netherlands; Faculty of Science, Biomedical Sciences Neurobiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Diana Sibai
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin Goodlett
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffery Lo
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kacie Hoyt
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Taylor
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa M Hazen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olha Halyabar
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Esra Meidan
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudy Schreiber
- Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, the Netherlands
| | - Margaret H Chang
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren A Henderson
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert P Sundel
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Lateral ankle instability-induced neuroplasticity in brain grey matter: A voxel-based morphometry MRI study. J Sci Med Sport 2021; 24:1240-1244. [PMID: 34281769 DOI: 10.1016/j.jsams.2021.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The deficits in sensory pathways caused by peripheral edema, pain, and inflammation of the damaged ligaments may induce maladaptive changes within the central nervous system. The purpose of this study was to determine whether patients with lateral ankle instability (LAI) exhibit morphological differences of brain grey matter when compared with healthy controls, and then assess the relationships between the observed differences and the characteristics of patients. DESIGN Cross-sectional. METHODS Thirty patients with LAI and 32 healthy controls without LAI underwent MRI scans using anatomical T1 sequences. A voxel-wise general linear model was used to compare the grey matter volume throughout the whole brain between patients and controls. Linear regression analyses were performed for the grey matter volume within the significant clusters to assess their relationship with age, sex, the existence of acute injury, pain level, sports activity level, and the duration of LAI within the patient group. RESULTS The grey matter volume of a cluster within the cerebellar vermis (Vermis_4_5 in automated anatomical labeling template) was significantly reduced in patients with LAI (Gaussian Random Field corrections with two-tailed p-cluster < 0.05 and p-voxel < 0.001). Multivariate linear regression analysis revealed that the duration of LAI tended to be passively associated with the grey matter volume of this LAI-related vermal cluster (p = 0.092). CONCLUSIONS Participants with LAI exhibited a reduced grey matter volume of a cluster within the cerebellar vermis compared with participants without LAI, and the degree of volume reduction tended to be positively associated with the duration of LAI.
Collapse
|
14
|
Mechanisms and Mediators of Pain in Chronic Inflammatory Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of the review
Pain in chronic inflammatory joint diseases is a common symptom reported by patients. Pain becomes of absolute clinical relevance especially when it becomes chronic, i.e., when it persists beyond normal healing times. As an operational definition, pain is defined chronic when it lasts for more than 3 months. This article aims to provide a review of the main mechanisms underlying pain in patients with chronic inflammatory joint diseases, discussing in particular their overlap.
Recent findings
While it may be intuitive how synovial inflammation or enthesitis are responsible for nociceptive pain, in clinical practice, it is common to find patients who continue to complain of symptoms despite optimal control of inflammation. In this kind of patients at the genesis of pain, there may be neuropathic or nociplastic mechanisms.
Summary
In the context of chronic inflammatory joint diseases, multiple mechanisms generally coexist behind chronic pain. It is the rheumatologist’s task to identify the mechanisms of pain that go beyond the nociceptive mechanisms, to adopt appropriate therapeutic strategies, including avoiding overtreatment of patients with immunosuppressive drugs. In this sense, future research will have to be oriented to search for biomarkers of non-inflammatory pain in patients with chronic inflammatory joint diseases.
Collapse
|
15
|
Iyer P, Lee YC. Why It Hurts: The Mechanisms of Pain in Rheumatoid Arthritis. Rheum Dis Clin North Am 2021; 47:229-244. [PMID: 33781492 DOI: 10.1016/j.rdc.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pain is a near-universal feature of rheumatoid arthritis, but peripheral joint inflammation may not suffice to explain the etiology of pain in all patients with rheumatoid arthritis. Inflammation in rheumatoid arthritis releases several algogens that may generate pain. Also, central nervous system processes may play a crucial role in the regulation and perpetuation of pain. Several methods for assessing pain in rheumatoid arthritis exist, and recently the role of assessing therapeutics in treating specific etiologies of pain has gained interest.
Collapse
Affiliation(s)
- Priyanka Iyer
- Division of Rheumatology, Department of Internal Medicine, University of California Irvine, Irvine, CA, USA.
| | | |
Collapse
|
16
|
Sebba A. Pain: A Review of Interleukin-6 and Its Roles in the Pain of Rheumatoid Arthritis. Open Access Rheumatol 2021; 13:31-43. [PMID: 33707975 PMCID: PMC7943546 DOI: 10.2147/oarrr.s291388] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022] Open
Abstract
Pain is a major and common symptom reported as a top priority in patients with rheumatoid arthritis (RA). Intuitively, RA-related pain is often considered to be a natural consequence of peripheral inflammation, so treatment of RA is expected to manage pain concurrently as part of inflammation control. However, pain in patients with RA can be poorly correlated with objective measures of inflammation, for example, in patients who are otherwise in remission. Joint damage appears to account for only a fraction of this residual pain. Emerging evidence suggests that alteration of peripheral and central pain processing contributes to RA-related pain; this is parallel to, but somewhat independent of, joint inflammation. Interleukin (IL)-6 is a proinflammatory cytokine that contributes to the pathogenesis of RA. It exerts systemic effects via signaling through soluble forms of the IL-6 receptor (“trans-signaling”). Evidence from preclinical studies demonstrates that intra-articular IL-6 can produce long-lasting peripheral sensitization to mechanical stimulation and suggests an important role for IL-6 in central pain sensitization. This may be partly explained by its ability to activate neurons through trans-signaling, affecting nociceptive plasticity and nerve fiber regrowth. Local activity at neuron endings may culminate in altered pain processing in the central nervous system because of persistent signaling from sensitized peripheral neurons. Peripheral and central sensitization can promote the development of chronic pain, which can have a significant impact on patients’ health and quality of life. A proportion of pain in RA may be more appropriately managed as an entity separate from inflammation. Both the peripheral and central nervous systems should be recognized as important potential systems targeted by RA. The substantial burden of RA-related chronic pain suggests that pain should be a key focus in RA management and should be assessed and addressed early and separately from the inflammatory component.
Collapse
Affiliation(s)
- Anthony Sebba
- Division of Rheumatology, University of South Florida, Tampa, FL, USA
| |
Collapse
|
17
|
Chronic noncancer pain is not associated with accelerated brain aging as assessed by structural magnetic resonance imaging in patients treated in specialized outpatient clinics. Pain 2021; 161:641-650. [PMID: 31764393 DOI: 10.1097/j.pain.0000000000001756] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic pain is often associated with changes in brain structure and function, and also cognitive deficits. It has been noted that these chronic pain-related alterations may resemble changes found in healthy aging, and thus may represent accelerated or premature aging of the brain. Here, we test the hypothesis that patients with chronic noncancer pain demonstrate accelerated brain aging compared with healthy control subjects. The predicted brain age of 59 patients with chronic pain (mean chronological age ± SD: 53.0 ± 9.0 years; 43 women) and 60 pain-free healthy controls (52.6 ± 9.0 years; 44 women) was determined using the software brainageR. This software segments the individual T1-weighted structural MR images into gray and white matter and compares gray and white matter images with a large (n = 2001) training set of structural images, using machine learning. Finally, brain age delta, which is the predicted brain age minus chronological age, was calculated and compared across groups. This study provided no evidence for the hypothesis that chronic pain is associated with accelerated brain aging (Welch t test, P = 0.74, Cohen's d = 0.061). A Bayesian independent-samples t test indicated moderate evidence in favor of the null hypothesis (BF01 = 4.875, ie, group means were equal). Our results provide indirect support for recent models of pain-related changes of brain structure, brain function, and cognitive functions. These models postulate network-specific maladaptive plasticity, rather than widespread or global neural degeneration.
Collapse
|
18
|
Basile MS, Ciurleo R, Bramanti A, Petralia MC, Fagone P, Nicoletti F, Cavalli E. Cognitive Decline in Rheumatoid Arthritis: Insight into the Molecular Pathogenetic Mechanisms. Int J Mol Sci 2021; 22:ijms22031185. [PMID: 33530359 PMCID: PMC7865873 DOI: 10.3390/ijms22031185] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
Cognitive decline refers to a deterioration of intellectual and learning abilities and related memory problems, and is often associated with behavioral alterations, which prevents sufferers from carrying out the most common daily activities, such as maintaining normal productive interpersonal relationships, communicating, and leading an autonomous life. Numerous studies have highlighted the association between cognitive decline and autoimmune disorders, including rheumatoid arthritis (RA). RA is a chronic, inflammatory, autoimmune disease that involves systems and organs other than the bones and joints, with varying severity among patients. Here, we review the studies investigating the link between cognitive decline and RA, focusing on the main molecular pathogenetic mechanisms involved. The emerging body of data suggests that clinical, psychological, and biological factors may contribute to the pathogenesis of cognitive decline in RA, including cardiovascular complications, chronic pain, depression, inflammatory factors, changes in hormone levels, drug side effects, and genetics. Further studies are warranted in order to fully clarify the basis underlying the association between cognitive decline and RA and to find new possible diagnostic strategies and therapeutic targets for RA patients.
Collapse
Affiliation(s)
- Maria Sofia Basile
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Rosella Ciurleo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Maria Cristina Petralia
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Paolo Fagone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
| | - Ferdinando Nicoletti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
- Correspondence:
| | - Eugenio Cavalli
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
| |
Collapse
|
19
|
Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
Collapse
Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
20
|
Lewis GN, Wartolowska KA, Parker RS, Sharma S, Rice DA, Kluger M, McNair PJ. A Higher Grey Matter Density in the Amygdala and Midbrain Is Associated with Persistent Pain Following Total Knee Arthroplasty. PAIN MEDICINE 2020; 21:3393-3400. [DOI: 10.1093/pm/pnaa227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Objective
The development of persistent pain following total knee arthroplasty (TKA) is common, but its underlying mechanisms are unknown. The goal of the study was to assess brain grey matter structure and its correlation with function of the nociceptive system in people with good and poor outcomes following TKA.
Subjects
Thirty-one people with LOW_PAIN (<3/10 on the numerical ratings scale [NRS]) at six months following TKA and 15 people with HIGH_PAIN (≥3/10 on the NRS) were recruited into the study.
Methods
Grey matter in key brain areas related to nociception was analyzed using voxel-based morphometry (VBM). Nociceptive facilitatory and inhibitory processes were evaluated using quantitative sensory testing (QST). QST scores and grey matter density in prespecified brain regions were compared between the LOW_PAIN and HIGH_PAIN groups. Regression analyses were used to analyze the associations between the grey matter and QST scores.
Results
There were no between-group differences in QST measures. In the VBM analysis, the HIGH_PAIN group had a higher grey matter density in the right amygdala, right nucleus accumbens, and in the periaqueductal grey (PAG), but lower grey matter density in the dorsal part of the left caudate nucleus. Grey matter density in the right amygdala and PAG correlated positively with temporal summation of pain.
Conclusions
Persistent pain at six months after TKA is associated with a higher grey matter density in the regions involved in central sensitization and pain-related fear, which may contribute to the development of persistent pain after surgery.
Collapse
Affiliation(s)
- Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | - Rosalind S Parker
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sheena Sharma
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - David A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Michal Kluger
- Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
21
|
Allen HN, Bobnar HJ, Kolber BJ. Left and right hemispheric lateralization of the amygdala in pain. Prog Neurobiol 2020; 196:101891. [PMID: 32730859 DOI: 10.1016/j.pneurobio.2020.101891] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/29/2020] [Accepted: 07/22/2020] [Indexed: 02/04/2023]
Abstract
Hemispheric asymmetries within the brain have been identified across taxa and have been extensively studied since the early 19th century. Here, we discuss lateralization of a brain structure, the amygdala, and how this lateralization is reshaping how we understand the role of the amygdala in pain processing. The amygdala is an almond-shaped, bilateral brain structure located within the limbic system. Historically, the amygdala was known to have a role in the processing of emotions and attaching emotional valence to memories and other experiences. The amygdala has been extensively studied in fear conditioning and affect but recently has been shown to have an important role in processing noxious information and impacting pain. The amygdala is composed of multiple nuclei; of special interest is the central nucleus of the amygdala (CeA). The CeA receives direct nociceptive inputs from the parabrachial nucleus (PBN) through the spino-parabrachio-amygdaloid pathway as well as more highly processed cortical and thalamic input via the lateral and basolateral amygdala. Although the amygdala is a bilateral brain region, most data investigating the amygdala's role in pain have been generated from the right CeA, which has an overwhelmingly pro-nociceptive function across pain models. The left CeA has often been characterized to have no effect on pain modulation, a dampened pro-nociceptive function, or most recently an anti-nociceptive function. This review explores the current literature on CeA lateralization and the hemispheres' respective roles in the processing and modulation of different forms of pain.
Collapse
Affiliation(s)
- Heather N Allen
- Department of Biological Sciences and Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA, 15282, United States
| | - Harley J Bobnar
- Department of Biological Sciences and Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA, 15282, United States
| | - Benedict J Kolber
- Department of Biological Sciences and Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA, 15282, United States; Department of Neuroscience and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, TX, 75080, United States.
| |
Collapse
|
22
|
PhysIOpathology of NEuromuscular function rElated to fatigue in chronic Renal disease in the elderly (PIONEER): study protocol. BMC Nephrol 2020; 21:305. [PMID: 32711479 PMCID: PMC7382847 DOI: 10.1186/s12882-020-01976-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is associated with reduced muscular strength resulting in profound fatigue. The physiopathology of these changes, their prevalence and evolution are still debated. Moreover, we have little data on elderly CKD patients. The present study protocol aims to 1) quantify the prevalence of low muscle strength (dynapenia) in a cohort of elderly patients with advanced CKD and to 2) characterize their force production coupled with electromyographic features and the symptoms of fatigue compared to a matched control group. METHODS This is a case-control, prospective, interventional study. INCLUSION CRITERIA age ≥ 60 years; CKD Stage 3b-5; clinical stability (i.e. no hospitalization and ≤ 25% in creatinine increase in the previous 3 months). Controls with normal kidney function will be matched in terms of age, gender and diabetes mellitus (requisite: estimated glomerular filtration rate ≥ 60 ml/min/1.73m2 available in the last 6 months). Exclusion criteria for cases and controls: neuromuscular disease, life expectancy < 3 months. The handgrip strength protocol is an intermittent test consisting in 6 series of 9 repetitions of 3-s sub-maximum contractions at 40% of the maximum voluntary contraction (MVC) and 2 s of resting time between contractions. Each series is separated by one fast sub-maximum contraction and one MVC. Strength is assessed with a high-frequency handgrip dynamometer paired with surface electromyography. Symptoms of fatigue are assessed using MFI-20 and FACIT-F questionnaires. In order to reach a statistical power of 96%, we plan to enroll 110 subjects in each group. DISCUSSION The novelty of this study resides in the application of an already validated set of tests in a population in which this combination (dynamometer, electromyography and questionnaires) has not previously been explored. We expect a high prevalence of dynapenia and a higher fatigability in CKD patients. A positive correlation is expected between reported fatigue and fatigability. Better appreciation of the prevalence and the relationship between fatigability and a sensation of fatigue can help us target interventions in CKD patients to improve quality of life and survival. TRIAL REGISTRATION The study was approved by Ethical Committee EST III n°20.03.01 and was recorded as a Clinical Trial (NCT04330807) on April 2, 2020.
Collapse
|
23
|
Korte SM, Straub RH. Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms. Rheumatology (Oxford) 2020; 58:v35-v50. [PMID: 31682277 PMCID: PMC6827268 DOI: 10.1093/rheumatology/kez413] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Today, inflammatory rheumatic disorders are effectively treated, but many patients still suffer from residual fatigue. This work presents pathophysiological mechanisms of fatigue. First, cytokines can interfere with neurotransmitter release at the preterminal ending. Second, a long-term increase in serum concentrations of proinflammatory cytokines increase the uptake and breakdown of monoamines (serotonin, noradrenaline and dopamine). Third, chronic inflammation can also decrease monoaminergic neurotransmission via oxidative stress (oxidation of tetrahydrobiopterin [BH4]). Fourth, proinflammatory cytokines increase the level of enzyme indoleamine-2, 3-dioxygenase activity and shunt tryptophan away from the serotonin pathway. Fifth, oxidative stress stimulates astrocytes to inhibit excitatory amino acid transporters. Sixth, astrocytes produce kynurenic acid that acts as an antagonist on the α7-nicotinic acetylcholine receptor to inhibit dopamine release. Jointly, these actions result in increased glutamatergic and decreased monoaminergic neurotransmission. The above-described pathophysiological mechanisms negatively affect brain functioning in areas that are involved in fatigue.
Collapse
Affiliation(s)
- S Mechiel Korte
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, (UIPS), Utrecht University, Utrecht, The Netherlands.,Department of Biopsychology, Faculty of Psychology, Ruhr-Universität, Bochum
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital, Regensburg, Germany
| |
Collapse
|
24
|
Methyl Jasmonate Reduces Inflammation and Oxidative Stress in the Brain of Arthritic Rats. Antioxidants (Basel) 2019; 8:antiox8100485. [PMID: 31618993 PMCID: PMC6826661 DOI: 10.3390/antiox8100485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022] Open
Abstract
Methyl jasmonate (MeJA), common in the plant kingdom, is capable of reducing articular and hepatic inflammation and oxidative stress in adjuvant-induced arthritic rats. This study investigated the actions of orally administered MeJA (75–300 mg/kg) on inflammation, oxidative stress and selected enzyme activities in the brain of Holtzman rats with adjuvant-induced arthritis. MeJA prevented the arthritis-induced increased levels of nitrites, nitrates, lipid peroxides, protein carbonyls and reactive oxygen species (ROS). It also prevented the enhanced activities of myeloperoxidase and xanthine oxidase. Conversely, the diminished catalase and superoxide dismutase activities and glutathione (GSH) levels caused by arthritis were totally or partially prevented. Furthermore, MeJA increased the activity of the mitochondrial isocitrate dehydrogenase, which helps to supply NADPH for the mitochondrial glutathione cycle, possibly contributing to the partial recovery of the GSH/oxidized glutathione (GSSG) ratio. These positive actions on the antioxidant defenses may counterbalance the effects of MeJA as enhancer of ROS production in the mitochondrial respiratory chain. A negative effect of MeJA is the detachment of hexokinase from the mitochondria, which can potentially impair glucose phosphorylation and metabolism. In overall terms, however, it can be concluded that MeJA attenuates to a considerable extent the negative effects caused by arthritis in terms of inflammation and oxidative stress.
Collapse
|
25
|
Sandström A, Ellerbrock I, Jensen KB, Martinsen S, Altawil R, Hakeberg P, Fransson P, Lampa J, Kosek E. Altered cerebral pain processing of noxious stimuli from inflamed joints in rheumatoid arthritis: An event-related fMRI study. Brain Behav Immun 2019; 81:272-279. [PMID: 31228612 DOI: 10.1016/j.bbi.2019.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To our knowledge, this is the first study assessing brain activation in response to painful stimulation over disease-relevant (finger joint) vs. neutral area (thumb nail) in patients suffering from rheumatoid arthritis (RA) compared to healthy controls (HC). METHOD Thirty-one RA patients and 23 HC underwent functional magnetic resonance imaging (fMRI) while stimulated with subjectively calibrated painful pressures corresponding to a pain sensation of 50 mm on a 100 mm VAS scale (P50) at disease-affected finger joint and thumbnail (left hand), and corresponding sites in HC. RESULTS Compared to controls, RA patients had significantly increased pain sensitivity (lower P50) at the inflamed joints but not at the thumbnail. RA patients exhibited significantly less activation in regions related to pain- and somatosensory processing (S1, M1, anterior insula, S2, SMG and MCC) during painful joint stimulation, compared to HC. No group difference in cerebral pain processing was found for the non-affected thumbnail. Within RA patients, significantly less brain activation was found in response to painful stimulation over disease-affected joint compared to non-affected thumbnail in bilateral S1, bilateral S2, and anterior insula. Further, RA patients exhibited a right-sided dlPFC deactivation, psycho-physiologically interacting (PPI) with the left dlPFC in response to painful stimulation at disease-affected joints. CONCLUSION The results indicate normal pain sensitivity and cerebral pain processing in RA for non-affected sites, while the increased sensitivity at inflamed joints indicate peripheral/spinal sensitization. Brain imaging data suggest that disease-relevant pain processing in RA is marked by aberrations and a failed initiation of cortical top-down regulation.
Collapse
Affiliation(s)
- A Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
| | - I Ellerbrock
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - K B Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - S Martinsen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - R Altawil
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Hakeberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - P Fransson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - J Lampa
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
26
|
Sundermann B, Dehghan Nayyeri M, Pfleiderer B, Stahlberg K, Jünke L, Baie L, Dieckmann R, Liem D, Happe T, Burgmer M. Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease-specific effects. Eur J Neurosci 2019; 50:3958-3967. [PMID: 31448468 DOI: 10.1111/ejn.14558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel-based morphometry and additional ROI-analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS-specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS-specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.
Collapse
Affiliation(s)
- Benedikt Sundermann
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Mahboobeh Dehghan Nayyeri
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Kim Stahlberg
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Leonie Jünke
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Lara Baie
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | - Dennis Liem
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | | | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| |
Collapse
|
27
|
Lewis GN, Parker RS, Sharma S, Rice DA, McNair PJ. Structural Brain Alterations Before and After Total Knee Arthroplasty: A Longitudinal Assessment. PAIN MEDICINE 2019; 19:2166-2176. [PMID: 29917139 DOI: 10.1093/pm/pny108] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective Many studies have provided evidence of altered brain structure in chronic pain conditions, as well as further adaptations following treatment that are coincident with changes in pain. Less is known regarding how these structural brain adaptations relate to assessments of nociceptive processing. The current study aimed to investigate brain structure in people with knee osteoarthritis (OA) before and after total knee arthroplasty (TKA) and to investigate the relationships between these findings and quantitative sensory testing (QST) of the nociceptive system. Methods Twenty-nine people with knee OA underwent magnetic resonance imaging (MRI) scans and QST before and six months after TKA and were compared with a pain-free control group (N = 18). MRI analyses involved voxel-based morphometry and fractional anisotropy. Results Before TKA, there was reduced gray matter volume and impaired fractional anisotropy in areas associated with nociceptive processing, with further gray matter adaptations and improvements in fractional anisotropy evident after TKA. QST revealed increased nociceptive facilitation and impaired inhibition in knee OA that was reversed after TKA. There were minimal relationships found between MRI data and QST assessments or pain report. Conclusions In people with end-stage knee OA, region-specific gray matter atrophy was detected, with further changes in gray matter volume and improvements in white matter integrity observed after joint replacement. Despite coincident alterations in nociceptive inhibition and facilitation processes, there did not appear to be any association between these functional assessments of the nociceptive system and changes in brain structure.
Collapse
Affiliation(s)
- Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Rosalind S Parker
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sheena Sharma
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - David A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Anaesthesiology and Perioperative Medicine, Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
28
|
Noda K, Tajima M, Oto Y, Saitou M, Yoshiga M, Otani K, Yoshida K, Kurosaka D. How do neuropathic pain-like symptoms affect health-related quality of life among patients with rheumatoid arthritis?: A comparison of multiple pain-related parameters. Mod Rheumatol 2019; 30:828-834. [PMID: 31398076 DOI: 10.1080/14397595.2019.1650462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Rheumatoid arthritis (RA) pain is thought to be nociceptive. However, recent studies indicate that RA also involves the neuropathic pain (NP) mechanism. We examined pain features and the effect of NP-like symptoms on health-related quality of life (HRQOL) among patients with RA.Methods: The painDETECT questionnaire (PDQ) was used to evaluate NP-like symptoms among 145 outpatients with RA. Disease activity, pain quality, and HRQOL were evaluated. We compared clinical parameters between patients with and without NP-like symptoms and analyzed pain features and the effect of NP-like symptoms on HRQOL, along with multiple other pain-related parameters.Results: Thirty (20.7%) patients had NP-like symptoms (PDQ ≥13). Patient global assessment and evaluator global assessment diverged for patients with RA who had NP-like symptoms. Of the examined pain-related parameters, PDQ score (p = .038, ß = -.173) was associated with the Short-Form 36-Item Health Survey role-social component summary score, but not with the physical or mental component summary scores.Conclusion: NP-like symptoms affected HRQOL among patients with RA. There was discordance between global assessments by patients and by evaluators for patients with RA who had NP-like symptoms. Therefore, NP-like symptoms should be given somewhat more attention when treating patients with RA.
Collapse
Affiliation(s)
- Kentaro Noda
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Miku Tajima
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohsuke Oto
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Moe Saitou
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Yoshiga
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Otani
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Yoshida
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Department of Rheumatology, Division of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
29
|
Genetic Risk for Rheumatoid Arthritis is Associated with Increased Striatal Volume in Healthy Young Adults. Sci Rep 2019; 9:10994. [PMID: 31358859 PMCID: PMC6662838 DOI: 10.1038/s41598-019-47505-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/24/2019] [Indexed: 01/11/2023] Open
Abstract
Rheumatoid arthritis (RA), an autoimmune disease, has recently been associated with increased striatal volume and decreased intracranial volume (ICV) in longstanding patients. As inflammation has been shown to precede the clinical diagnosis of RA and it is a known moderator of neuro- and gliogenesis, we were interested in testing whether these brain morphological changes appear before the clinical onset of disease in healthy young adult volunteers, as a function of relative genetic risk for RA. Genetic and structural MRI data were available for 516 healthy non-Hispanic Caucasian university students (275 women, mean age 19.78 ± 1.24 years). Polygenic risk scores were computed for each individual based on a genome-wide association study of RA, so that higher scores indicated higher risk. Striatal volume (sum of caudate, putamen, and nucleus accumbens volumes) and ICV were derived for each individual from high-resolution T1-weighted images. After controlling for sex, age, genetic components of ethnicity, socioeconomic status, and depressive symptoms, we found that higher RA polygenic risk scores were associated with increased striatal volume, but not decreased ICV. Our findings suggest that increased striatal volume may be linked to processes that precede disease onset, such as inflammation, while decreased ICV may relate to disease progression.
Collapse
|
30
|
Forsberg A, Lampa J, Estelius J, Cervenka S, Farde L, Halldin C, Lekander M, Olgart Höglund C, Kosek E. Disease activity in rheumatoid arthritis is inversely related to cerebral TSPO binding assessed by [ 11C]PBR28 positron emission tomography. J Neuroimmunol 2019; 334:577000. [PMID: 31260948 DOI: 10.1016/j.jneuroim.2019.577000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Reumatoid Arthritis (RA) is an autoimmune disorder characterized by peripheral joint inflammation. Recently, an engagement of the brain immune system has been proposed. The aim with the current investigation was to study the glial cell activation marker translocator protein (TSPO) in a well characterized cohort of RA patients and to relate it to disease activity, peripheral markers of inflammation and autonomic activity. Fifteen RA patients and fifteen healthy controls matched for age, sex and TSPO genotype (rs6971) were included in the study. TSPO was measured using Positron emission tomography (PET) and the radioligand [11C]PBR28. The outcome measure was total distribution volume (VT) estimated using Logan graphical analysis, with grey matter (GM) as the primary region of interest. Additional regions of interest analyses as well as voxel-wise analyses were also performed. Clinical evaluation of disease activity, symptom assessments, serum analyses of cytokines and heart rate variability (HRV) analysis of 24 h ambulatory ECG were performed in all subjects. There were no statistically significant group differences in TSPO binding, either when using the primary outcome VT or when normalizing VT to the lateral occipital cortex (p > 0.05). RA patients had numerically lower VT values than healthy controls (Cohen's D for GM = -0.21). In the RA group, there was a strong negative correlation between [11C]PBR28 VT in GM and disease activity (DAS28)(r = -0.745, p = 0.002, corrected for rs6971 genotype). Higher serum levels of IFNγ and TNF-α were found in RA patients compared to controls (p < 0.05) and several measures of autonomic activity showed significant differences between RA and controls (p < 0.05). However, no associations between markers of systemic inflammation or autonomic activity and cerebral TSPO binding were found. In conclusion, no statistically significant group differences in TSPO binding as measured with [11C]PBR28 PET were detected. Within the RA group, lower cerebral TSPO binding was associated with higher disease activity, suggesting that cerebral TSPO expression may be related to disease modifying mechanisms in RA. In light of the earlier confirmed neuro-immune features of RA, these results warrant further investigations regarding neuro-immune joint-to-CNS signalling to open up for potentially new treatment strategies.
Collapse
Affiliation(s)
- A Forsberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden.
| | - J Lampa
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Estelius
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S Cervenka
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden
| | - L Farde
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden; PET Science Centre, Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Karolinska Institutet, Sweden
| | - C Halldin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden
| | - M Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - C Olgart Höglund
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - E Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
31
|
|
32
|
Nair VA, Dodd K, Rajan S, Santhanubosu A, Beniwal-Patel P, Saha S, Prabhakaran V. A Verbal Fluency Task-Based Brain Activation fMRI Study in Patients with Crohn's Disease in Remission. J Neuroimaging 2019; 29:630-639. [PMID: 31134699 DOI: 10.1111/jon.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND PURPOSE In this pilot study, we investigated functional brain activation changes in patients with Crohn's disease (CD) in remission compared to age and gender-matched healthy controls (HCs). METHODS Data from 20 patients with CD in remission (age range 19-63 years) and 20 HCs (matched in age and gender) were analyzed. Task functional MRI (fMRI) data were collected while participants performed a cognitive (phonemic verbal fluency) task in the scanner. All participants also performed the same task outside the scanner. RESULTS Task fMRI results showed greater bi-hemispheric activation in CD patients compared to controls. Because this pattern is commonly reported with normal aging, we performed further analyses to investigate fMRI responses in a subset of the younger CD patients (N = 12, age < = 35 years) compared to matched young HCs (age < = 35 years), and an older cohort of HCs (age > = 50 years). Results showed that task activation patterns were similar between young CD patients and older HCs, and that both groups differed significantly from younger HCs. Activation intensity in specific brain regions for patients was associated with disease duration. CONCLUSIONS These results suggest that CD patients in remission may show accelerated signs of aging in terms of brain responses to a typical cognitive task. Future work with larger sample size will need to replicate these results as well as investigate the influence of factors, such as chronicity of the disease and medication effects on task-associated brain activation patterns in this patient population.
Collapse
Affiliation(s)
- Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Keith Dodd
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Shruti Rajan
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anu Santhanubosu
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, Madison, WI
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| |
Collapse
|
33
|
Duration of the Symptoms and Brain Aging in Women with Fibromyalgia: A Cross-Sectional Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9102106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibromyalgia is a chronic syndrome that is characterized by widespread pain and an altered brain dynamic. The aim of this study was to analyze the effect of the duration of the symptoms on the cortical activity of women with fibromyalgia using electroencephalogram power spectrum analyses in an eye-closed resting state. Twenty-nine women participated in this cross-sectional study (N: 29; age: 55.59 [9.50]). Theta, alpha, beta-1, beta-2, and beta-3 frequency bands were analyzed using EEGLAB. Theta power significantly correlated with the duration of the symptoms, but not with age. In addition, participants were divided into two groups according to number the years for which they were suffering from fibromyalgia. Participants who had a longer duration of symptoms obtained higher theta power in the frontal (Fp1, F4, F7, F8, and Fz), central (C3, C4, and Cz), and parietal (P3 and Pz) areas than those who had a shorter duration of symptoms, which may be related to brain aging. This exploratory study demonstrates for the first time that the frontal, central, and parietal areas may be influenced by the years in which they were suffering from the symptoms of fibromyalgia. This might indicate that the duration of these symptoms may have a higher impact on brain aging than the actual age of the patient.
Collapse
|
34
|
Karateev AE, Nasonov EL. Chronic pain and central sensitization in immuno-inflammatory rheumatic diseases: pathogenesis, clinical manifestations, the possibility of using targeted disease modifying antirheumatic drugs. RHEUMATOLOGY SCIENCE AND PRACTICE 2019. [DOI: 10.14412/1995-4484-2019-197-209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic pain is one of the main manifestations of immuno-inflammatory rheumatic diseases (IIRD), such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which determines the severity of suffering, reduced quality of life and disability of patients. Unfortunately, the use of synthetic and biological disease modifying antirheumatic drugs, as well as non-steroidal anti-inflammatory drugs does not always provide sufficient control of pain in IIRD, even when it is possible to achieve a significant reduction in inflammatory activity. The reason for this is the complex mechanism of chronic pain. It includes not onlystimulation of pain receptors caused by damage of the elements of the musculoskeletal system, but also a change in the perception of pain associated with the phenomenon of central sensitization (CS). CS is characterized by a significant and persistent increase in the sensitivity of nociceptive neurons to pain and nonpain stimuli. One of the main theories of the CS development consider this phenomenon as an inflammatory reaction of the neuronenvironmentthe activation of astrocytes and microglial cells, local hyperproduction of cytokines, inflammatory mediators and neurotrophic factors. Factors contributing to the development of CS in IIRD are obesity, depression and anxiety, damage of the somatosensory system, insufficient relief of pain in the onset of the disease. Clinical manifestations of CS in IIRD is hyperalgesia, allodinia, «expanded pain» and secondary fibromyalgia. An important role in the development of chronic pain and CS plays the intracellular inflammatory pathway JAK-STAT. Therefore, JAK inhibitors, such as tofacitinib, used in RA and PsA, can also be considered as an effective means of controlling chronic pain in these diseases.
Collapse
Affiliation(s)
| | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| |
Collapse
|
35
|
Abstract
Active research is being conducted on musculoskeletal pain, and recent concepts will help clinicians and researchers to develop better approaches: -the new pain taxonomy recently has been modified with a third descriptor with the concept of nociplastic pain. -the latest International Classification of Diseases (ICD-11) includes an IASP task force that developed a new classification system for pain. In this new classification, one can differentiate primary musculoskeletal pain including fibromyalgia and low back pain and secondary musculoskeletal pain related to specific etiologies. -the concept of central sensitization in inflammatory rheumatic diseases is increasingly discussed. In these conditions, even with very active biological treatment, almost a third of patients are still complaining of persisting pain. These persisting pain states under adequate treatment, without any sign of inflammation, led researchers to look for evidence of central sensitization states.
Collapse
Affiliation(s)
- Anne-Priscille Trouvin
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, 9 avenue Charles de Gaulle, 92100, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Serge Perrot
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, 9 avenue Charles de Gaulle, 92100, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| |
Collapse
|
36
|
Tracey I, Woolf CJ, Andrews NA. Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment. Neuron 2019; 101:783-800. [PMID: 30844399 PMCID: PMC6800055 DOI: 10.1016/j.neuron.2019.02.019] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 02/09/2023]
Abstract
Pain is a subjective sensory experience that can, mostly, be reported but cannot be directly measured or quantified. Nevertheless, a suite of biomarkers related to mechanisms, neural activity, and susceptibility offer the possibility-especially when used in combination-to produce objective pain-related indicators with the specificity and sensitivity required for diagnosis and for evaluation of risk of developing pain and of analgesic efficacy. Such composite biomarkers will also provide improved understanding of pain pathophysiology.
Collapse
Affiliation(s)
- Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - Clifford J Woolf
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, 02115 MA, USA.
| | - Nick A Andrews
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, 02115 MA, USA
| |
Collapse
|
37
|
Chen J, Yan Y, Yuan F, Cao J, Li S, Eickhoff SB, Zhang J. Brain grey matter volume reduction and anxiety-like behavior in lipopolysaccharide-induced chronic pulmonary inflammation rats: A structural MRI study with histological validation. Brain Behav Immun 2019; 76:182-197. [PMID: 30472482 DOI: 10.1016/j.bbi.2018.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/01/2018] [Accepted: 11/21/2018] [Indexed: 12/26/2022] Open
Abstract
While there have been multiple fMRI studies into the brain functional changes after acutely stimulated peripheral infection, knowledge for the effect of chronic peripheral infection on whole brain morphology is still quite limited. The present study was designed to investigate the brain structural and emotional changes after peripheral local infection initiated chronic systemic inflammation and the relationship between circulating inflammatory markers and brain grey matter. Specifically, in-vivo T2-weighted MRI was performed on rats with lipopolysaccharide (LPS)-induced chronic pulmonary inflammation (CPI) and those without. Grey matter volume was quantified using diffeomorphic anatomical registration through exponentiated lie (DARTEL) enhanced voxel-based morphometry followed by between-group comparison. Open field experiment was conducted to test the potential anxiety-like behaviors after CPI, along with the ELISA estimated inflammatory markers were correlated to grey matter volume. Guided by image findings, we undertook a focused histological investigation with immunefluorescence and Nissl staining. A widespread decrease of grey matter volume in CPI-model rats was revealed. 8 of the 12 measured inflammatory markers presented differential neuroanatomical correlation patterns with three of the pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) and CRP being the most notable. Lower grey matter volumes in some of the inflammatory markers related regions (amygdala, CA2 and cingulate cortex) were associated with more-severe anxiety-like behaviors. Furthermore, grey matter volumes in amygdala and CA3 were correlated negatively with the expressions of glial proteins (S100β and Nogo-A), while the grey matter volume in hypo-thalamus was changing positively with neural cell area. Overall, the neuroanatomical association patterns and the histopathology underpinning the MRI observations we demonstrated here would probably serve as one explanation for the cerebral and emotional deficits presented in the patients with CPI, which would furthermore yield new insights into the adverse effects the many other systemic inflammation and inflammatory autoimmune diseases would pose on brain morphology.
Collapse
Affiliation(s)
- Ji Chen
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, China; Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Ya Yan
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, China
| | - Fengjuan Yuan
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, China
| | - Jianbo Cao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China; Medical College of Xiamen University, Xiamen, China; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Shanhua Li
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, China
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, China.
| |
Collapse
|
38
|
Inflammation in the hippocampus affects IGF1 receptor signaling and contributes to neurological sequelae in rheumatoid arthritis. Proc Natl Acad Sci U S A 2018; 115:E12063-E12072. [PMID: 30509997 PMCID: PMC6305002 DOI: 10.1073/pnas.1810553115] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aberrant insulin-like growth factor 1 receptor (IGF1R)/insulin receptor signaling in brain has recently been linked to neurodegeneration in diabetes mellitus and in Alzheimer’s disease. In this study, we demonstrate that functional disability and pain in patients with rheumatoid arthritis (RA) and in experimental RA are associated with hippocampal inflammation and inhibition of IGF1R/insulin receptor substrate 1 (IRS1) signal, reproducing an IGF1/insulin-resistant state. This restricts formation of new neurons in the hippocampus, reduces hippocampal volume, and predisposes RA patients to develop neurological symptoms. Improving IRS1 function through down-regulation of IGF1R disinhibits neurogenesis and can potentially ameliorate neurological symptoms. This opens perspectives for drugs that revert IGF1/insulin resistance as an essential complement to the antirheumatic and antiinflammatory arsenal. Rheumatoid arthritis (RA) is an inflammatory joint disease with a neurological component including depression, cognitive deficits, and pain, which substantially affect patients’ quality of daily life. Insulin-like growth factor 1 receptor (IGF1R) signaling is one of the factors in RA pathogenesis as well as a known regulator of adult neurogenesis. The purpose of this study was to investigate the association between IGF1R signaling and the neurological symptoms in RA. In experimental RA, we demonstrated that arthritis induced enrichment of IBA1+ microglia in the hippocampus. This coincided with inhibitory phosphorylation of insulin receptor substrate 1 (IRS1) and up-regulation of IGF1R in the pyramidal cell layer of the cornus ammoni and in the dentate gyrus, reproducing the molecular features of the IGF1/insulin resistance. The aberrant IGF1R signaling was associated with reduced hippocampal neurogenesis, smaller hippocampus, and increased immobility of RA mice. Inhibition of IGF1R in experimental RA led to a reduction of IRS1 inhibition and partial improvement of neurogenesis. Evaluation of physical functioning and brain imaging in RA patients revealed that enhanced functional disability is linked with smaller hippocampus volume and aberrant IGF1R/IRS1 signaling. These results point to abnormal IGF1R signaling in the brain as a mediator of neurological sequelae in RA and provide support for the potentially reversible nature of hippocampal changes.
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Pain in rheumatoid arthritis (RA) may be due to different etiologies, ranging from peripheral inflammation to dysregulation of central nervous system (CNS) processing. This review evaluates relevant literature published on RA pain mechanisms in recent years. RECENT FINDINGS Despite successes of disease-modifying antirheumatic drugs (DMARDs), pain persists for many RA patients. Studies involving patient-reported outcomes, quantitative sensory testing, and neuroimaging indicate that, in addition to joint inflammation, abnormalities in CNS pain processing may contribute to pain. Some DMARDs (e.g., janus kinus inhibitors) may work via multiple pathways to decrease pain. Adjunctive treatments (e.g., antidepressants, antiepileptics) may also be useful in managing pain in RA patients with well-controlled disease. Both peripheral and central mechanisms play key roles in the expression of pain in RA. To effectively manage pain, physicians need accurate assessment tools to identify the pathways involved in each patient so that treatments may be appropriately targeted.
Collapse
Affiliation(s)
- Angela Zhang
- Commonwealth Honors College University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Yvonne C Lee
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| |
Collapse
|
40
|
Wang Y, Fang JL, Cui B, Liu J, Song P, Lang C, Bao Y, Sun R, Xu C, Ding X, Yan Z, Yan Y, Kong Q, Kong J. The functional and structural alterations of the striatum in chronic spontaneous urticaria. Sci Rep 2018; 8:1725. [PMID: 29379058 PMCID: PMC5789061 DOI: 10.1038/s41598-018-19962-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/11/2018] [Indexed: 12/16/2022] Open
Abstract
The brain has long been known to be the regulation center of itch, but the neuropathology of chronic itch, such as chronic spontaneous urticaria (CSU), remains unclear. Thus, we aimed to explore the brain areas involved in the pathophysiology of CSU in hopes that our results may provide valuable insights into the treatment of chronic itch conditions. 40 CSU patients and 40 healthy controls (HCs) were recruited. Urticaria activity scores 7 (UAS7) were collected to evaluate patient’s clinical symptoms. Amplitude of low frequency fluctuations (ALFF), voxel-based morphometry (VBM), and seed-based resting-state functional connectivity (rs-FC) analysis were used to assess brain activity and related plasticity. Compared with HCs, CSU patients exhibited 1) higher ALFF values in the right ventral striatum / putamen, which were positively associated with clinical symptoms as measured by UAS7; 2) gray matter volume (GMV) increase in the right ventral striatum and putamen; and 3) decreased rs-FC between the right ventral striatum and the right occipital cortex and between the right putamen and the left precentral gyrus. Using multiple-modality brain imaging tools, we demonstrated the dysfunction of the striatum in CSU. Our results may provide valuable insights into the neuropathology and development of chronic itch.
Collapse
Affiliation(s)
- Yuming Wang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China. .,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.
| | - Ji-Liang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Bingnan Cui
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jiao Liu
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, China
| | - Ping Song
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA
| | - Yan Bao
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ruirui Sun
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA
| | - Chenchen Xu
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xu Ding
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Zhifang Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuhe Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Qian Kong
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA 02129, USA.
| |
Collapse
|
41
|
Upadhyay J, Geber C, Hargreaves R, Birklein F, Borsook D. A critical evaluation of validity and utility of translational imaging in pain and analgesia: Utilizing functional imaging to enhance the process. Neurosci Biobehav Rev 2018; 84:407-423. [PMID: 28807753 PMCID: PMC5729102 DOI: 10.1016/j.neubiorev.2017.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
Assessing clinical pain and metrics related to function or quality of life predominantly relies on patient reported subjective measures. These outcome measures are generally not applicable to the preclinical setting where early signs pointing to analgesic value of a therapy are sought, thus introducing difficulties in animal to human translation in pain research. Evaluating brain function in patients and respective animal model(s) has the potential to characterize mechanisms associated with pain or pain-related phenotypes and thereby provide a means of laboratory to clinic translation. This review summarizes the progress made towards understanding of brain function in clinical and preclinical pain states elucidated using an imaging approach as well as the current level of validity of translational pain imaging. We hypothesize that neuroimaging can describe the central representation of pain or pain phenotypes and yields a basis for the development and selection of clinically relevant animal assays. This approach may increase the probability of finding meaningful new analgesics that can help satisfy the significant unmet medical needs of patients.
Collapse
Affiliation(s)
| | - Christian Geber
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany; DRK Schmerz-Zentrum Mainz, Mainz, Germany
| | - Richard Hargreaves
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States
| | - Frank Birklein
- Department of Neurology, University Medical Centre Mainz, Mainz, Germany
| | - David Borsook
- Center for Pain and the Brain, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, United States.
| |
Collapse
|
42
|
Oláh C, Kardos Z, Sepsi M, Sas A, Kostyál L, Bhattoa HP, Hodosi K, Kerekes G, Tamási L, Valikovics A, Bereczki D, Szekanecz Z. Assessment of intracranial vessels in association with carotid atherosclerosis and brain vascular lesions in rheumatoid arthritis. Arthritis Res Ther 2017; 19:213. [PMID: 28950911 PMCID: PMC5615800 DOI: 10.1186/s13075-017-1422-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI). Methods Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI. Results MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis. Conclusions To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.
Collapse
Affiliation(s)
- Csaba Oláh
- Department of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Zsófia Kardos
- Department of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Mariann Sepsi
- Department of Radiology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Attila Sas
- Department of Neurology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - László Kostyál
- Department of Radiology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Hodosi
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Street, H-4032, Debrecen, Hungary
| | - György Kerekes
- Department of Angiology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - László Tamási
- Department of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Attila Valikovics
- Department of Neurology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Dániel Bereczki
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Zoltán Szekanecz
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Street, H-4032, Debrecen, Hungary.
| |
Collapse
|
43
|
Alam J, Jantan I, Bukhari SNA. Rheumatoid arthritis: Recent advances on its etiology, role of cytokines and pharmacotherapy. Biomed Pharmacother 2017; 92:615-633. [PMID: 28582758 DOI: 10.1016/j.biopha.2017.05.055] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/01/2017] [Accepted: 05/10/2017] [Indexed: 01/13/2023] Open
Abstract
An autoimmune disease is defined as a clinical syndrome resulted from an instigation of both T cell and B cell or individually, in the absence of any present infection or any sort of distinguishable cause. Clonal deletion of auto reactive cells remains the central canon of immunology for decades, keeping the role of T cell and B cell aside, which are actually the guards to recognize the entry of foreign body. According to NIH, 23.5 million Americans are all together affected by these diseases. They are rare, but with the exception of RA. Rheumatoid arthritis is chronic and systemic autoimmune response to the multiple joints with unknown ethology, progressive disability, systemic complications, early death and high socioeconomic costs. Its ancient disease with an old history found in North American tribes since 1500 BCE, but its etiology is yet to be explored. Current conventional and biological therapies used for RA are not fulfilling the need of the patients but give only partial responses. There is a lack of consistent and liable biomarkers of prognosis therapeutic response, and toxicity. Rheumatoid arthritis is characterized by hyperplasic synovium, production of cytokines, chemokines, autoantibodies like rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA), osteoclastogensis, angiogenesis and systemic consequences like cardiovascular, pulmonary, psychological, and skeletal disorders. Cytokines, a diverse group of polypeptides, play critical role in the pathogenesis of RA. Their involvement in autoimmune diseases is a rapidly growing area of biological and clinical research. Among the proinflammatory cytokines, IL-1α/β and TNF-α trigger the intracellular molecular signalling pathway responsible for the pathogenesis of RA that leads to the activation of mesenchymal cell, recruitment of innate and adaptive immune system cells, activation of synoviocytes which in term activates various mediators including tumour necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6) and interleukin-8 (IL-8), resulting in inflamed synovium, increase angiogenesis and decrease lymphangiogensis. Their current pharmacotherapy should focus on their three phases of progression i.e. prearthritis phase, transition phase and clinical phase. In this way we will be able to find a way to keep the balance between the pro and anti-inflammatory cytokines that is believe to be the dogma of pathogenesis of RA. For this we need to explore new agents, whether from synthetic or natural source to find the answers for unresolved etiology of autoimmune diseases and to provide a quality of life to the patients suffering from these diseases specifically RA.
Collapse
Affiliation(s)
- Javaid Alam
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Ibrahim Jantan
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Syed Nasir Abbas Bukhari
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.
| |
Collapse
|
44
|
Aissouni Y, El Guerrab A, Hamieh AM, Ferrier J, Chalus M, Lemaire D, Grégoire S, Etienne M, Eschalier A, Ardid D, Lingueglia E, Marchand F. Acid-Sensing Ion Channel 1a in the amygdala is involved in pain and anxiety-related behaviours associated with arthritis. Sci Rep 2017; 7:43617. [PMID: 28321113 PMCID: PMC5340794 DOI: 10.1038/srep43617] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/30/2017] [Indexed: 12/17/2022] Open
Abstract
Chronic pain is associated with anxiety and depression episodes. The amygdala plays a key role in the relationship between emotional responses and chronic pain. Here, we investigated the role of Acid-Sensing Ion Channels 1a within the basolateral amygdala (BLA), in pain and associated anxiety in a rat model of monoarthritis (MoAr). Administration within the BLA of PcTx1 or mambalgin-1, two specific inhibitors of ASIC1a-containing channels significantly inhibited pain and anxiety-related behaviours in MoAr rats. The effect of PcTx1 was correlated with a reduction of c-Fos expression in the BLA. We examined the expression profile of ASICs and other genes in the amygdala in MoAr and sham animals, and found no variation of the expression of ASIC1a, which was confirmed at the protein level. However, an increase in the BLA of MoAr rats of both PI3Kinase mRNA and the phosphorylated form of Akt, along with Bdnf mRNA, suggest that the BDNF/PI3-kinase/Akt pathway might regulate ASIC1a in BLA neurons as demonstrated in spinal sensitisation phenomenon. We also observed changes in several kinase mRNAs expression (PICK1, Sgk1) that are potentially involved in ASIC1a regulation. These results show a crucial role of ASIC1a channels in the BLA in pain and anxiety-related behaviours during arthritis.
Collapse
Affiliation(s)
- Youssef Aissouni
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Abderrahim El Guerrab
- Centre Jean Perrin, ERTICA EA4677 Université d'Auvergne F-63001, Clermont-Ferrand, France
| | - Al Mahdy Hamieh
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Jérémy Ferrier
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Maryse Chalus
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Diane Lemaire
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Stéphanie Grégoire
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Monique Etienne
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Alain Eschalier
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France.,CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Denis Ardid
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| | - Eric Lingueglia
- Université Côte d'Azur, CNRS, IPMC, Valbonne, France.,LabEx Ion Channel Science and Therapeutics, Valbonne, France
| | - Fabien Marchand
- Clermont Université, Université d'Auvergne, Pharmacologie fondamentale et clinique de la douleur, F-63000 Clermont-Ferrand, France.,Inserm U1107 NEURO-DOL, F-63001 Clermont-Ferrand, France
| |
Collapse
|
45
|
|
46
|
Alshuft HM, Condon LA, Dineen RA, Auer DP. Cerebral Cortical Thickness in Chronic Pain Due to Knee Osteoarthritis: The Effect of Pain Duration and Pain Sensitization. PLoS One 2016; 11:e0161687. [PMID: 27658292 PMCID: PMC5033394 DOI: 10.1371/journal.pone.0161687] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/10/2016] [Indexed: 12/27/2022] Open
Abstract
Objective This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis. Methods Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years), and 30 healthy controls (age = 62.7± 7.4, 17 females). Results Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected). Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected) with no changes surviving multiple test correction. Conclusion With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role.
Collapse
Affiliation(s)
- Hamza M. Alshuft
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Laura A. Condon
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Division of Rehabilitation and Aging, the University of Nottingham, Nottingham, United Kingdom
| | - Robert A. Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Dorothee P. Auer
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
- * E-mail:
| |
Collapse
|
47
|
Nair VA, Beniwal-Patel P, Mbah I, Young BM, Prabhakaran V, Saha S. Structural Imaging Changes and Behavioral Correlates in Patients with Crohn's Disease in Remission. Front Hum Neurosci 2016; 10:460. [PMID: 27695405 PMCID: PMC5025433 DOI: 10.3389/fnhum.2016.00460] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/31/2016] [Indexed: 11/27/2022] Open
Abstract
Background: Crohn’s disease (CD) is a subtype of inflammatory bowel disease caused by immune-mediated inflammation in the gastrointestinal tract. The extent of morphologic brain alterations and their associated cognitive and affective impairments remain poorly characterized. Aims: We used magnetic resonance imaging to identify structural brain differences between patients with Crohn’s disease in remission compared to age-matched healthy controls and evaluated for structural-behavioral correlates. Methods: Nineteen patients and 20 healthy, age-matched controls were recruited in the study. Group differences in brain morphometric measures and correlations between brain measures and performance on a cognitive task, the verbal fluency (VF) task, were examined. Correlations between brain measures and cognitive measures as well as self-reported measures of depression, personality, and affective scales were examined. Results: Patients showed significant cortical thickening in the left superior frontal region compared to controls. Significant group differences were observed in sub-cortical volume measures in both hemispheres. Investigation of brain-behavior correlations revealed significant group differences in the correlation between cortical surface area and VF performance, although behavioral performance was equivalent between the two groups. The left middle temporal surface area was a significant predictor of VF performance with controls showing a significant positive correlation between these measures, and patients showing the opposite effect. Conclusion: Our results indicate key differences in structural brain measures in patients with CD compared to controls. Additionally, correlation between brain measures and behavioral responses suggest there may be a neural basis to the alterations in patients’ cognitive and affective responses.
Collapse
Affiliation(s)
- Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison WI, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, University of Wisconsin - Madison, Madison WI, USA
| | - Ifeanyi Mbah
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, MadisonWI, USA; Division of Gastroenterology and Hepatology, University of Wisconsin - Madison, MadisonWI, USA
| | - Brittany M Young
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, MadisonWI, USA; Medical Scientist Training Program, University of Wisconsin - Madison, MadisonWI, USA; Neuroscience Training Program, University of Wisconsin - Madison, MadisonWI, USA
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, MadisonWI, USA; Medical Scientist Training Program, University of Wisconsin - Madison, MadisonWI, USA; Neuroscience Training Program, University of Wisconsin - Madison, MadisonWI, USA; Department of Neurology, University of Wisconsin - Madison, MadisonWI, USA; Department of Psychology and Department of Psychiatry, University of Wisconsin - Madison, MadisonWI, USA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin - Madison, Madison WI, USA
| |
Collapse
|
48
|
Flodin P, Martinsen S, Altawil R, Waldheim E, Lampa J, Kosek E, Fransson P. Intrinsic Brain Connectivity in Chronic Pain: A Resting-State fMRI Study in Patients with Rheumatoid Arthritis. Front Hum Neurosci 2016; 10:107. [PMID: 27014038 PMCID: PMC4791375 DOI: 10.3389/fnhum.2016.00107] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/26/2016] [Indexed: 01/21/2023] Open
Abstract
Background: Rheumatoid arthritis (RA) is commonly accompanied by pain that is discordant with the degree of peripheral pathology. Very little is known about the cerebral processes involved in pain processing in RA. Here we investigated resting-state brain connectivity associated with prolonged pain in RA. Methods: 24 RA subjects and 19 matched controls were compared with regard to both behavioral measures of pain perception and resting-resting state fMRI data acquired subsequently to fMRI sessions involving pain stimuli. The resting-state fMRI brain connectivity was investigated using 159 seed regions located in cardinal pain processing brain regions. Additional principal component based multivariate pattern analysis of the whole brain connectivity pattern was carried out in a data driven analysis to localize group differences in functional connectivity. Results: When RA patients were compared to controls, we observed significantly lower pain resilience for pressure on the affected finger joints (i.e., P50-joint) and an overall heightened level of perceived global pain in RA patients. Relative to controls, RA patients displayed increased brain connectivity predominately for the supplementary motor areas, mid-cingulate cortex, and the primary sensorimotor cortex. Additionally, we observed an increase in brain connectivity between the insula and prefrontal cortex as well as between anterior cingulate cortex and occipital areas for RA patients. None of the group differences in brain connectivity were significantly correlated with behavioral parameters. Conclusion: Our study provides experimental evidence of increased connectivity between frontal midline regions that are implicated in affective pain processing and bilateral sensorimotor regions in RA patients.
Collapse
Affiliation(s)
- Pär Flodin
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Sofia Martinsen
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Reem Altawil
- Department of Medicine, Rheumatology Unit, CMM, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Eva Waldheim
- Department of Medicine, Rheumatology Unit, CMM, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Jon Lampa
- Department of Medicine, Rheumatology Unit, CMM, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - Peter Fransson
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| |
Collapse
|
49
|
Mao CP, Bai ZL, Zhang XN, Zhang QJ, Zhang L. Abnormal Subcortical Brain Morphology in Patients with Knee Osteoarthritis: A Cross-sectional Study. Front Aging Neurosci 2016; 8:3. [PMID: 26834629 PMCID: PMC4717185 DOI: 10.3389/fnagi.2016.00003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
Despite the involvement of subcortical brain structures in the pathogenesis of chronic pain and persistent pain as the defining symptom of knee osteoarthritis (KOA), little attention has been paid to the morphometric measurements of these subcortical nuclei in patients with KOA. The purpose of this study is to explore the potential morphological abnormalities of subcortical brain structures in patients with KOA as compared to the healthy control subjects by using high-resolution MRI. Structural MR data were acquired from 26 patients with KOA and 31 demographically similar healthy individuals. The MR data were analyzed by using FMRIB’s integrated registration and segmentation tool. Both volumetric analysis and surface-based shape analysis were performed to characterize the subcortical morphology. The normalized volumes of bilateral caudate nucleus were significantly smaller in the KOA group than in the control group (P = 0.004). There was also a trend toward smaller volume of the hippocampus in KOA as compared to the control group (P = 0.027). Detailed surface analyses further localized these differences with a greater involvement of the left hemisphere (P < 0.05, corrected) for the caudate nucleus. Hemispheric asymmetry (right larger than left) of the caudate nucleus was found in both KOA and control groups. Besides, no significant correlation was found between the structural data and pain intensities. Our results indicated that patients with KOA had statistically significant smaller normalized volumes of bilateral caudate nucleus and a trend toward smaller volume of the hippocampus as compared to the control subjects. Further investigations are necessary to characterize the role of caudate nucleus in the course of chronicity of pain associated with KOA.
Collapse
Affiliation(s)
- Cui Ping Mao
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Zhi Lan Bai
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Xiao Na Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Qiu Juan Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| | - Lei Zhang
- Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University College of Medicine , Xi'an , China
| |
Collapse
|
50
|
Sergeeva M, Rech J, Schett G, Hess A. Response to peripheral immune stimulation within the brain: magnetic resonance imaging perspective of treatment success. Arthritis Res Ther 2015; 17:268. [PMID: 26477946 PMCID: PMC4610054 DOI: 10.1186/s13075-015-0783-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic peripheral inflammation in diseases such as rheumatoid arthritis leads to alterations in central pain processing and consequently to mood disorders resulting from sensitization within the central nervous system and enhanced vulnerability of the medial pain pathway. Proinflammatory cytokines such as tumor necrosis factor (TNF) alpha play an important role herein, and therapies targeting their signaling (i.e., anti-TNF therapies) have been proven to achieve good results. However, the phenomenon of rapid improvement in the patients’ subjective feeling after the start of TNFα neutralization remained confusing, because it was observed long before any detectable signs of inflammation decline. Functional magnetic resonance imaging (fMRI), enabling visualization of brain activity upon peripheral immune stimulation with anti-TNF, has helped to clarify this discrepancy. Moreover, fMRI appeared to work as a reliable tool for predicting prospective success of anti-TNF therapy, which is valuable considering the side effects of the drugs and the high therapy costs. This review, which is mainly guided by neuroimaging studies of the brain, summarizes the state-of-the-art knowledge about communication between the immune system and the brain and its impact on subjective well-being, addresses in more detail the outcome of the abovementioned anti-TNF fMRI studies (rapid response to TNFα blockade within the brain pain matrix and differences in brain activation patterns between prospective therapy responders and nonresponders), and discusses possible mechanisms for the latter phenomena and the predictive power of fMRI.
Collapse
Affiliation(s)
- Marina Sergeeva
- Institut for Experimental Pharmacology, Friedrich Alexander University Erlangen-Nürnberg, Fahrstrasse 17, 91054, Erlangen, Germany.
| | - Jürgen Rech
- Department of Internal Medicine III, Friedrich Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Georg Schett
- Department of Internal Medicine III, Friedrich Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Andreas Hess
- Institut for Experimental Pharmacology, Friedrich Alexander University Erlangen-Nürnberg, Fahrstrasse 17, 91054, Erlangen, Germany.
| |
Collapse
|