New insights into the impact of neuro-inflammation in rheumatoid arthritis

• Published in: Frontiers in neuroscience Vol. 8; p. 357
• Main Authors: Fuggle, Nicholas R, Howe, Franklyn A, Allen, Rachel L, Sofat, Nidhi
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 06.11.2014; Frontiers Media S.A
• Subjects: Alzheimer's disease; Antigen presentation; Autoimmune diseases; Compression; Consortia; Cytokines; Endocrinology; Functional magnetic resonance imaging; Genomes; Host-pathogen interactions; Immune system; Immunoglobulins; Immunosuppressive agents; Infection; Infections; Inflammation; lipopolysaccharide; Lipopolysaccharides; Lupus; Medical imaging; Nervous system; Neuroimaging; Neuroinflammation; Pain; Pathogenesis; Peptides; Proteins; Quality of life; Rheumatoid arthritis; Rheumatology; Sensory neurons; Thalamus; TNF inhibitors; tumor necrosis factor alpha; Tumor necrosis factor-TNF; Tumor necrosis factor-α; United Kingdom > UK; infection; tumor necrosis factor alpha; lipopolysaccharide; neuroinflammation; rheumatoid arthritis; neuroimaging
• ISSN: 1662-4548; 1662-453X; 1662-453X
• DOI: 10.3389/fnins.2014.00357

Rheumatoid arthritis (RA) is considered to be, in many respects, an archetypal autoimmune disease that causes activation of pro-inflammatory pathways resulting in joint and systemic inflammation. RA remains a major clinical problem with the development of several new therapies targeted at cytokine inhibition in recent years. In RA, biologic therapies targeted at inhibition of tumor necrosis factor alpha (TNFα) have been shown to reduce joint inflammation, limit erosive change, reduce disability and improve quality of life. The cytokine TNFα has a central role in systemic RA inflammation and has also been shown to have pro-inflammatory effects in the brain. Emerging data suggests there is an important bidirectional communication between the brain and immune system in inflammatory conditions like RA. Recent work has shown how TNF inhibitor therapy in people with RA is protective for Alzheimer's disease. Functional MRI studies to measure brain activation in people with RA to stimulus by finger joint compression, have also shown that those who responded to TNF inhibition showed a significantly greater activation volume in thalamic, limbic, and associative areas of the brain than non-responders. Infections are the main risk of therapies with biologic drugs and infections have been shown to be related to disease flares in RA. Recent basic science data has also emerged suggesting that bacterial components including lipopolysaccharide induce pain by directly activating sensory neurons that modulate inflammation, a previously unsuspected role for the nervous system in host-pathogen interactions. In this review, we discuss the current evidence for neuro-inflammation as an important factor that impacts on disease persistence and pain in RA.