446 PAIN PROCESSING IN RHEUMATOID ARTHRITIS PATIENTS SUCCESSFULLY TREATED WITH ANTI-TNF MEDICATION
2009
Introduction: Anti-TNF treatment blocks the action of proinflammatory
cytokine, tumor necrosis factor, and reduces pain and
disease activity in rheumatoid arthritis (RA). We were interested in
changes in processing of evoked pain in RA patients after successful
anti-TNF treatment.
Methods: Ten patients with severe RA were scanned before the
beginning of treatment and after 6 months of successful therapy.
22 healthy volunteers were recruited as a control group and were
scanned only once. We used fMRI to investigate brain activation
changes in response to joint pressure pain and thermal stimulation
at a fixed temperature to elicit moderate pain.
Results: At the baseline, the comparison of moderately painful
pressure pain in patients vs. non-painful pressure stimulation in
controls revealed more extensive activation in the anterior cingulate
cortex, the brainstem and bilaterally in the thalamus and insula.
As for the thermal stimulation, patients and controls rated it
as moderately painful, however, there was less activation in the
thalamus and insula in patients than in controls. Patients were
scanned again after six months of the treatment and the same
stimulation intensity was used as at the baseline. Joint pressure
pain was rated significantly lower, whereas thermal pain ratings
remained the same. In comparison to the control group imaging
data, patients showed more activation in response to pressure
stimulation in the cingulate cortex and brainstem; patients’ brain
activation in response to thermal stimulation was not different
from controls.
Conclusions: We observed a normalization of pain processing after
successful anti-TNF treatment.
The study was funded by GlaxoSmithKline as a part of an ongoing
academic collaboration.
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