Assessment of Intracranial Circulation in Rheumatoid Arthritis

This study appears to be the first of its kind to use transcranial Doppler to assess intracranial arteries in rheumatoid arthritis.

Results from a study published in Arthritis Research & Therapy found more pronounced distal occlusion and resistance of the middle cerebral artery (MCA), as well as impaired circulatory reserve capacity (CRC), in patients with rheumatoid arthritis (RA) compared with controls.

To examine the association of stroke with RA, researchers in this Hungarian study used transcranial Doppler to assess intracranial arteries in patients with RA and also used carotid ultrasonography and brain magnetic resonance imaging in the same patients.

A total of 40 female patients with RA who were being treated with methotrexate or a biologic agent and 60 age-matched female controls underwent transcranial Doppler assessment of the MCA and the basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI), and CRC were all determined at rest (r), as well as after apnea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) was also established. Brain magnetic resonance images were used to ascertain the presence of intracerebral lesions.

Regarding clinical and laboratory characteristics, the total RA cohort, the methotrexate-treated group, and the biologic treatment group did not differ from each other in most respects. However, patients in the methotrexate arm had significantly higher C-reactive protein levels and mean 28-joint Disease Activity Score compared with those in the biologic treatment arm (5.3 ± 3.9 mg/L vs 3.4 ± 4.7 mg/L, respectively; P <.05 and 2.88 ± 0.75 vs 22.6 ± 0.86, respectively; P =.006).

MCA PI(r), PI(a), RI(r), and RI(r) values were significantly increased in the total RA cohort and in methotrexate-treated patients vs controls. MCA CRC was impaired and basilar artery PI was higher in patients with RA compared with controls. More participants with RA also had carotid plaques and elevated cIMT.

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According to linear regression analysis, left PI(r) and RI(r) were linked with disease duration, and left PI(r), RI(r), PI(a), PI(h), and basilar PI were all correlated with disease activity. Right CRC was inversely associated with 28-joint Disease Activity Score. Moreover, disease activity was an independent predictor of left PI(a) and right CRC. The use of biologic therapy in combination with methotrexate, compared with long-term treatment with methotrexate alone, was associated with less impaired cerebral circulation. In addition, impaired cerebral circulation was linked with measures of carotid atherosclerosis.

The investigators concluded that biologic therapy in patients with RA may influence some parameters in the intracranial vessels beneficially, and that “preclinical cerebrovascular screening may be important in determining stroke risk in individuals with RA.”


Oláh C, Kardos Z, Sepsi M, et al. Assessment of intracranial vessels in association with carotid atherosclerosis and brain vascular lesions in rheumatoid arthritis. Arthritis Res Ther. 2017;19:213.