Artritis reumatoide

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ARTHRITIS & RHEUMATISM Vol. 58, No. 12, December 2008, pp 3960–3969 DOI 10.1002/art.24070 © 2008, American College of Rheumatology

White and Gray Matter Abnormalities in the Brain of Patients With Fibromyalgia
A Diffusion-Tensor and Volumetric Imaging Study
J¨rgen Lutz,1 Lorenz J¨ger,1 Dominique de Quervain,2 Till Krauseneck,1 Frank Padberg,1 u a Martina Wichnalek,1 Antje Beyer,1 RobertStahl,1 Ben Zirngibl,1 Dominik Morhard,1 Maximilian Reiser,1 and Gustav Schelling1
Objective. To use a combination of magnetic resonance diffusion-tensor imaging (MR-DTI) and MR imaging of voxel-based morphometry (MR-VBM) in patients with fibromyalgia syndrome (FMS) to determine microstructural and volume changes in the central neuronal networks involved in the sensorydiscriminative andaffective-motivational characteristics of pain, anxiety, memory, and regulation of the stress response. Methods. Thirty female patients with FMS and 30 healthy female control subjects were studied. Predefined areas of the brain were measured for volume of gray matter by MR-VBM and for diffusivity and fractional anisotropy (FA) by MR-DTI. Higher FA values and reduced diffusivity are thought to reflect increasedcomplexity of brain-tissue microstructure. Results. MR-VBM and MR-DTI demonstrated a striking pattern of changes in brain morphology in patients with FMS. Both thalami, the thalamocortical tracts, and both insular regions showed significant decreases in FA. In contrast, increases in FA and
Supported by funds from the Departments of Anaesthesiology and Radiology, Klinikum Grosshadern,Ludwig-Maximilians University. 1 Jurgen Lutz, MD, Lorenz Jager, MD, PhD, Till Krauseneck, ¨ ¨ MD, Frank Padberg, MD, PhD, Martina Wichnalek, MD, Antje Beyer, MD, Robert Stahl, MD, Ben Zirngibl, MD, Dominik Morhard, MD, Maximilian Reiser, MD, PhD, Gustav Schelling, MD, PhD: Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany; 2 Dominique de Quervain, MD, PhD: University of Zurich, Zurich,Switzerland. Address correspondence and reprint requests to Gustav Schelling, MD, PhD, Ludwig-Maximilians University, Klinikum Grosshadern, Department of Anaesthesiology, Marchioninistrasse 15, 81377 Munich, Germany. E-mail: Submitted for publication November 24, 2007; accepted in revised form August 24, 2008. 3960

decreases in gray matter volume were seen in thepostcentral gyri, amygdalae, hippocampi, superior frontal gyri, and anterior cingulate gyri. Increased pain intensity scores were correlated with changes in MRDTI measurements in the right superior frontal gyrus. Increased fatigue was correlated with changes in the left superior frontal and left anterior cingulate gyrus, and self-perceived physical impairment was correlated with changes in theleft postcentral gyrus. Higher intensity scores for stress symptoms were correlated negatively with diffusivity in the thalamus and FA in the left insular cortex. No relationship was found between MRVBM measurements and symptom intensity scores. Conclusion. MR-DTI allows the visualization of microstructural changes in the brain of patients with FMS, appears to be more sensitive than MR-VBM, and mayserve as an additional diagnostic technique in FMS and probably other dysfunctional pain syndromes. Fibromyalgia syndrome (FMS) belongs to a group of common functional somatic syndromes that are characterized by chronic widespread pain and are often accompanied by functional disturbance (dizziness, vertigo, palpitations, and peripheral edema) in different organ systems and symptoms of sleepdisturbance, anxiety, memory problems, fatigue, and exhaustion. Because of the association between FMS development and severe organic illness, accidents, or stressful life events, FMS has also been regarded as a stress-related disorder (1). The combination of chronic widespread pain, sleep disturbance, and pronounced and ongoing stress symptoms is highly disabling, yet there is no universally...