ORIGINAL ARTICLE Assessment of biocorrelates for brain involvement in female patients with rheumatoid arthritis Sherifa A. Hamed & Zahra I. Selim & Amal M. Elattar & Yasser M. Elserogy & Eman A. Ahmed & Hanan O. Mohamed Received: 4 February 2010 / Revised: 1 June 2011 / Accepted: 5 June 2011 / Published online: 22 June 2011 # Clinical Rheumatology 2011 Abstract Central nervous system (CNS) abnormalities are rare in patients with rheumatoid arthritis (RA). Direct studies done to investigate brain involvement in RA are few or even absent. We hypothesized that CNS is not excluded from the inflammatory disease process in RA. Thus we systematically investigated markers of brain involvement in 55 females with RA. We examined patients' cognition using battery of sensitive psychometric testing [Mini-Mental State Examination, Stanford–Binet test (fourth edition) and Wechsler Memory Scale—Revised] and by recording P300 component of event-related poten- tials, a neurophysiological analogue. We also measured the serum levels of S100B and neuron-specific enolase (NSE), markers of glial and neuronal cells. Compared to control subjects, lower scores in cognitive testing were reported in 71% of the patients (n = 39) and abnormal P300 latency and amplitude (P < 0.001, 0.050). Patients had higher levels of S100B (P < 0.029) and higher levels of S100B were correlated with lower total scores of cognitive functions (P < 0.01), P300 latency (P < 0.05), and NSE concentrations (P < 0.01). However, cognitive scores did not correlate with disease activity or severity. Although depression scores were significant in patients with RA (P < 0.001), but they did not correlate with cognitive scores. Seven patients had white matter hyperintensities in MRI brain suggesting vasculitis, ischemic brain lesions and dots of demyelination, and all had higher levels of S100B. Results of this study directly indicate that the disease process (inflammation and demyelination) is associated with cognitive deficits observed with RA. Keywords Cognition . Neuron-specific enolase . Rheumatoid arthritis . S100B . Vasculitis Introduction Rheumatoid arthritis (RA) is an inflammatory multisystem connective tissue disorder affecting joints with approximated prevalence in white populations of northern European and North American of 0.5–1%, and a mean annual incidence of 0.02–0.05% [1]. Whereas reports from Africa note a rising incidence, for example in Egyptian population, the preva- lence of RA is approximately 0.3% [2]. Peripheral nervous system abnormalities are common with RA [3–5]; however, reports about central nervous system (CNS) and brain changes are sporadically reported [6–23]. Vasculitis is defined as vessel wall inflammation with or without necrosis. Although secondary CNS vasculitis is a well-documented pathology in connective tissue diseases S. A. Hamed (*) : Y. M. Elserogy Department of Neurology and Psychiatry, Assiut University Hospital, P.O. Box 71516, Assiut, Egypt e-mail: hamed_sherifa@yahoo.com Z. I. Selim Department of Rheumatology and Rehabilitation, Sohag Faculty of Medicine, South Valley University, Sohag, Egypt A. M. Elattar Audiology Unit, Assiut University Hospital, Assiut, Egypt E. A. Ahmed Department of Radiology, Assiut University Hospital, Assiut, Egypt H. O. Mohamed Department of Clinical Pathology, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt Clin Rheumatol (2012) 31:123–132 DOI 10.1007/s10067-011-1795-1