Arya Akanksha, Sinha Abhishek, Yadav Raj Kumar, Venkataraman Srikumar, Kumar Uma, Bhatia Renu
Department of Physiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Department of Physiology, All India Institute of Medical Sciences, Guwahati, Guwahati, IND.
Cureus. 2023 Jul 18;15(7):e42101. doi: 10.7759/cureus.42101. eCollection 2023 Jul.
Rheumatoid arthritis (RA) has been defined by the American College of Rheumatology in 1987 as a chronic inflammatory disease characterised by joint swelling, joint tenderness, and destruction of synovial joints leading to severe disability and premature mortality. There is a paucity of literature assessing corticomotor excitability in RA patients. This study aimed to assess the effect of motor imagery on corticomotor excitability and pain status in RA patients. The specific objectives were to study the effect of motor imagery on corticomotor excitability and pain status in RA patients. We also wanted to compare the corticomotor excitability between RA patients with healthy controls. The correlation between the measures of corticomotor excitability and pain status in RA patients has also been done.
The study was designed as a pilot clinical trial with a case-control design. Forty participants were recruited for the study. Twenty RA patients were recruited from the Department of Rheumatology and Department of Physical Medicine and Rehabilitation (PMR), AIIMS, New Delhi, and 20 healthy controls. Testing was performed at the Pain Research & rTMS Lab, Department of Physiology, AIIMS, New Delhi. The study was approved by the Institute Ethics Committee, AIIMS New Delhi, and registered in the Clinical Trials Registry-India (CTRI). For the subjective assessment of pain, the visual analogue scale (VAS), Short-Form McGill Pain Questionnaire, WHO-Quality of Life Brief questionnaire (WHO-QOL-BREF), and Rheumatoid Arthritis Pain Scale were used. For the objective assessment of pain, hot and cold pain thresholds were assessed using thermo-tactile quantitative sensory testing (QST) using the method of limits and corticomotor excitability using a transcranial magnetic stimulation device. All participants were also asked to perform motor imagery tasks which consisted of a metronome-paced thumb opposition paradigm. Results: The resting motor threshold (RMT) decreased significantly after motor imagery when compared to the mental calculation group. The amplitude of motor evoked potential (MEP) and QST parameter value was comparable in both the groups before and after motor imagery and mental calculation. RMT was found to be significantly higher whereas MEP values were found to be significantly lower in RA compared to controls.
We conclude that patients suffering from RA have decreased corticomotor excitability compared to controls. Motor imagery was effective in improving corticomotor excitability in these patients and can be used as rehabilitation in RA to relieve their pain.
美国风湿病学会于1987年将类风湿关节炎（RA）定义为一种慢性炎症性疾病，其特征为关节肿胀、压痛以及滑膜关节破坏，可导致严重残疾和过早死亡。评估RA患者皮质运动兴奋性的文献较少。本研究旨在评估运动想象对RA患者皮质运动兴奋性和疼痛状态的影响。具体目标是研究运动想象对RA患者皮质运动兴奋性和疼痛状态的影响。我们还想比较RA患者与健康对照者之间的皮质运动兴奋性。此外，还对RA患者皮质运动兴奋性测量指标与疼痛状态之间的相关性进行了研究。
本研究设计为一项采用病例对照设计的试点临床试验。招募了40名参与者。从新德里全印医学科学研究所（AIIMS）的风湿病科和物理医学与康复科（PMR）招募了20名RA患者以及20名健康对照者。测试在新德里AIIMS生理系的疼痛研究与重复经颅磁刺激实验室进行。该研究获得了新德里AIIMS机构伦理委员会的批准，并在印度临床试验注册中心（CTRI）注册。对于疼痛的主观评估，使用了视觉模拟量表（VAS）、简式麦吉尔疼痛问卷、世界卫生组织生活质量简表（WHO-QOL-BREF）和类风湿关节炎疼痛量表。对于疼痛的客观评估，使用极限法通过热触觉定量感觉测试（QST）评估冷热痛阈值，并使用经颅磁刺激设备评估皮质运动兴奋性。所有参与者还被要求执行由节拍器-paced拇指对掌范式组成的运动想象任务。结果：与心算组相比，运动想象后静息运动阈值（RMT）显著降低。运动想象和心算前后两组的运动诱发电位（MEP）幅度和QST参数值相当。与对照组相比，RA患者的RMT显著更高，而MEP值显著更低。
我们得出结论，与对照组相比，RA患者的皮质运动兴奋性降低。运动想象对改善这些患者的皮质运动兴奋性有效，可作为RA的康复手段以缓解其疼痛。
