Alhashim Maryam, Basu Neil, Murray Alison, Waiter Gordon
Medical Physics Department, Medical Imaging Services Canter, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
BJR Open. 2025 May 24;7(1):tzaf014. doi: 10.1093/bjro/tzaf014. eCollection 2025 Jan.
Rheumatoid arthritis (RA) patients frequently report fatigue, which notably diminishes their quality of life. Emerging research points to a correlation between inflammation-induced fatigue and brain structural alterations.
This study evaluates the variance in myelin integrity among patients with RA-related fatigue, investigating the potential of magnetization transfer ratio (MTR) as a biomarker, in comparison with healthy controls.
A prospective cohort analysis was conducted comprised 60 RA patients with fatigue, categorized into active ( = 30) and non-active ( = 30) disease states, alongside 20 healthy controls (HC). A 3 Tesla MRI system was utilized to perform diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) sequences. MTR maps were generated using in-house MATLAB code and co-registered with DTI data using SPM8. These were then analyzed through tract-based spatial statistics (TBSS) with threshold-free cluster enhancement (TFCE) and corrected for multiple comparisons. MTR values were assessed using Randomize from the FSL toolkit, applying a general linear model (GLM) for voxel-wise analysis and TFCE for p-value generation, with family-wise error (FWE) control ( < .05) for multiple comparisons.
The RF group exhibited significantly lower myelin integrity (TFCE, < .05) compared to HCs, particularly in the middle cerebellar peduncle and splenium of the corpus callosum, with no marked difference between active and non-active RA disease statuses. There is a discernible disparity in myelin integrity between RA patients with fatigue and healthy individuals, suggesting microstructural white matter alterations that are congruent with DTI findings.
This study reveals that rheumatoid arthritis (RA) patients with fatigue exhibit significantly lower myelin integrity, particularly in the middle cerebellar peduncle and splenium of the corpus callosum, compared to healthy controls. Notably, this finding was consistent regardless of the active or non-active status of the RA disease, highlighting persistent white matter alterations in this patents cohort.
The research demonstrates that magnetization transfer ratio (MTR) imaging can effectively map microstructural changes in RA patients with fatigue, suggesting its potential as a biomarker for assessing white matter integrity in this condition. While it does not establish a direct causal relationship, it provides valuable insights into the role of MTR mapping in understanding brain alterations in patients with fatigue-related RA.
类风湿关节炎（RA）患者经常报告疲劳，这显著降低了他们的生活质量。新出现的研究指出炎症诱导的疲劳与脑结构改变之间存在关联。
本研究评估类风湿关节炎相关疲劳患者的髓鞘完整性差异，与健康对照相比，研究磁化传递率（MTR）作为生物标志物的潜力。
进行了一项前瞻性队列分析，纳入60例有疲劳症状的类风湿关节炎患者，分为疾病活动期（n = 30）和非活动期（n = 30），同时纳入20名健康对照（HC）。使用3特斯拉MRI系统进行扩散张量成像（DTI）和磁化传递成像（MTI）序列。使用内部MATLAB代码生成MTR图，并使用SPM8与DTI数据进行配准。然后通过基于纤维束的空间统计学（TBSS）和无阈值聚类增强（TFCE）进行分析，并对多重比较进行校正。使用FSL工具包中的Randomize评估MTR值，应用一般线性模型（GLM）进行体素水平分析，使用TFCE生成p值，采用家族性错误（FWE）控制（<0.05）进行多重比较。
与健康对照相比，类风湿关节炎组的髓鞘完整性显著降低（TFCE，<0.05），特别是在小脑中脚和胼胝体压部，疾病活动期和非活动期类风湿关节炎患者之间无明显差异。有疲劳症状的类风湿关节炎患者与健康个体之间在髓鞘完整性上存在明显差异，提示白质微观结构改变与DTI结果一致。
本研究表明，与健康对照相比，有疲劳症状的类风湿关节炎患者的髓鞘完整性显著降低，特别是在小脑中脚和胼胝体压部。值得注意的是，无论类风湿关节炎疾病处于活动期还是非活动期，这一发现都是一致的，突出了该患者队列中持续存在的白质改变。
该研究表明，磁化传递率（MTR）成像可以有效地描绘有疲劳症状的类风湿关节炎患者的微观结构变化，提示其作为评估这种情况下白质完整性的生物标志物的潜力。虽然它没有建立直接的因果关系，但它为MTR映射在理解与疲劳相关的类风湿关节炎患者脑改变中的作用提供了有价值的见解。
