Abstract Details

Title Brain Structural and Functional Alterations in Regions of Pain-processing in Individuals with Rheumatoid Arthritis

Topic Autoimmune Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 2-002

Objective This study examined alterations in brain structure and resting-state functional connectivity (rs-fMRI) in Rheumatoid Arthritis (RA) compared to healthy controls (HC) and explored relationships with disease activity.

Background RA is a chronic autoimmune disease associated with joint inflammation and systemic manifestations. Despite effective disease-modifying antirheumatic drugs many patients report persistent pain disproportionate to inflammation, suggesting central sensitization and nociplastic mechanisms.

Design/Methods

Individuals with RA and HC were prospectively enrolled. All participants completed the Clinical Disease Activity Index questionnaire (CDAI) to assess RA disease severity and underwent brain structural (T1-weighted) and resting-state functional MRI (rs-fMRI). Functional connectivity was evaluated across 63 a priori defined pain-related brain regions, with results corrected for multiple comparisons (FDR). Group differences were analyzed using ANOVA models adjusted for age and sex.

Results This study included 10 individuals with RA (mean age= 58.3; SD=11.6; 9 females/1 male) and 11 HC (mean age= 56.7; SD=10.2; 9 females/2 males). Nine individuals with RA completed the CDAI (mean score=19.1, SD=15.2). Compared to HC, RA patients showed stronger connectivity between the right primary somatosensory cortex and right supramarginal gyrus, and between the left lateral parietal cortex and left lingual gyrus. RA patients had smaller bilateral thalamus, left amygdala, right choroid plexus, and central cingulate volume, and greater right insula volume (all p<0.05, uncorrected for multiple comparisons). Within RA, higher CDAI scores correlate with stronger connectivity between the left supramarginal and left middle cingulate cortex.

Conclusions

Individuals with RA demonstrated functional and structural reorganization of key pain-processing regions, including networks involved in sensory-discriminative processes and visual-sensory integration. Correlations of higher disease activity with stronger fc between the left supramarginal and middle cingulate is consistent with the role of the cingulate in pain attention and appraisal. These findings highlight widespread reorganization of nociceptive and cognitive-affective processes in RA.

Authors/Disclosures
Catherine D. Chong, PhD, FAAN PRESENTER	Dr. Chong has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for HCOP.
Juna Musa, MD	Miss Musa has nothing to disclose.
Cynthia Crowson (Mayo Clinic)	Cynthia Crowson has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Rheumatology.
Anushka Irani, MD, PhD	Dr. Irani has nothing to disclose.
Todd J. Schwedt, MD, FAAN (Mayo Clinic)	Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. The institution of Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Salvia. Dr. Schwedt has or had stock in Nocira.Dr. Schwedt has or had stock in Allevalux. The institution of Dr. Schwedt has received research support from National Institutes of Health. The institution of Dr. Schwedt has received research support from United States Department of Defense. The institution of Dr. Schwedt has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Schwedt has received research support from Henry Jackson Foundation. The institution of Dr. Schwedt has received research support from Pfizer. The institution of Dr. Schwedt has received research support from National Headache Foundation. The institution of Dr. Schwedt has received research support from American Heart Association. The institution of Dr. Schwedt has received research support from AbbVie. The institution of Dr. Schwedt has received research support from Flinn Foundation. Dr. Schwedt has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received publishing royalties from a publication relating to health care.
Kirk M. Welker, MD	The institution of Dr. Welker has received research support from Mayo Clinic.
John M. Davis III, MD, MS	Dr. Davis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Journal of Rheumatology. Dr. Davis has received intellectual property interests from a discovery or technology relating to health care. Dr. Davis has received intellectual property interests from a discovery or technology relating to health care.