Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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.
Brain Res. 2024 Jun 1;1832:148862. doi: 10.1016/j.brainres.2024.148862. Epub 2024 Mar 11.
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.
To automatically identify alteration of white matter microstructure in patients with RA and further examine how this alteration associates with clinical characteristics.
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.
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.
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.
结构性和功能性脑成像研究报告称，类风湿关节炎（RA）患者的灰质形态和功能活动存在异常。然而，RA 患者的白质微观结构组织是否存在改变还知之甚少。
自动识别 RA 患者的白质微观结构改变，并进一步研究这种改变与临床特征的关系。
这项单机构前瞻性研究纳入了 66 名参与者（33 名 RA 患者[52±9 岁，29 名女性]和 33 名性别/年龄匹配的健康对照者[53±12 岁，27 名女性]），他们于 2021 年 1 月至 2021 年 12 月接受了弥散 MRI 扫描。使用各向异性分数、平均扩散系数、轴向扩散系数和径向扩散系数评估白质微观结构。使用自动、观察者独立的基于束的空间统计学分析对白质骨架进行体素分析。使用相关性分析评估白质微观结构改变与临床和神经心理学变量之间的关系。
与健康对照组相比，RA 患者在几个主要白质束中表现出较低的各向异性分数（经阈值自由聚类增强校正，多重比较校正，置换检验 P<0.05），包括小内囊、双侧下额枕束、双侧内囊前辐射束和双侧钩束。RA 患者的各向异性分数较低与疼痛相关评估显著相关，包括压痛关节计数（r=-0.43，P=0.015）、临床疾病活动指数评分（r=-0.36，P=0.049）、视觉模拟评分法（r=-0.45，P=0.012）和简化疾病活动指数评分（r=-0.36，P=0.045）。在平均扩散系数、轴向扩散系数和径向扩散系数方面，两组间无显著差异。
我们首次报道了类风湿关节炎患者几个主要白质束结构异常及其与疼痛处理之间的关联的解剖学证据。
