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Disease activity and cognition in rheumatoid arthritis: an open label pilot study

Graham Raftery1*, Jiabao He2, Ruth Pearce3, Daniel Birchall4, Julia L Newton3, Andrew M Blamire2 and John D Isaacs25

Author Affiliations

1 Department of Rheumatology, City Hospitals Sunderland NHS Trust, Kayll Road, Sunderland, SR4 7TP, UK

2 Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK

3 Institute of Ageing and Health and NIHR Biomedical Research Centre in Ageing, Campus for Ageing and Vitality, Newcastle-upon-Tyne, NE4 5PL, UK

4 Neuroradiology Department, Regional Neurosciences Centre, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK

5 Musculoskeletal Unit, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK

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Arthritis Research & Therapy 2012, 14:R263  doi:10.1186/ar4108

Published: 4 December 2012



We hypothesised that fatigue in rheumatoid arthritis (RA) is related to TNF-alpha induced dysregulation of cerebral blood flow. Our objectives were to assess fatigue, cognitive function and cerebral blood flow before and after initiation of anti-TNF treatment.


In a pilot study, 15 patients initiating treatment with adalimumab were assessed for fatigue using a visual analogue scale (FACIT-F), cognitive function using a panel of psychometric tests and regional cerebral blood flow using MR perfusion imaging.


Patients improved clinically after anti-TNF therapy in terms of DAS28 and FACIT-F. Furthermore significant improvements were documented in full scale, verbal and performance IQ following therapy. There was a non-significant trend towards reduced cerebral perfusion in both grey and white matter, and fatigue at 3 months correlated with cerebral blood flow in white (p = 0.014) and grey (p = 0.005) matter.


We demonstrate for the first time a significant improvement in cognitive function following effective treatment of RA. Although we observed minor reductions in cerebral blood flow, and a correlation between cerebral blood flow and fatigue, a larger, controlled study would be required to affirm a causal relationship.