Precuneus hyperactivity may serve as an important diagnostic biomarker of RA

According to a recent study published in the European Journal of Medical Research, increased left precuneus activation in rheumatoid arthritis (RA) patients impacts visuospatial function and is strongly associated with disease activity. The researchers suggest that hyperactivity of the precuneus may serve as a pivotal neuroimaging indicator of visuospatial impairment among individuals with RA. 

Zheng and colleagues conducted the study involving a total of 27 RA patients, consisting of 16 with active disease and 11 in remission, between December 2019 and April 2021. Additionally, 27 well-matched controls were selected from the Department of Rheumatology at the First Affiliated Hospital of Shantou University Medical College. During the rotation task, RA patients demonstrated hyperactivity in the left precuneus, left superior frontal gyrus, and right cingulate gyrus, with a notable dominance of the left hemisphere in comparison to the control group. Among the findings, a negative correlation emerged between the accuracy of the mental rotation task (MRT) and the Disease Activity Score 28 (DAS28) in RA patients. Moreover, a negative correlation was evident between the activation of the left precuneus and MRT, while a positive correlation was established between the activation of the precuneus and both MRT and the DAS28. 

Research has demonstrated a connection between cognitive impairment and disease activity in patients with RA. Lee et al. reported notable differences in verbal fluency and the Boston naming test outcomes between RA patients and their healthy counterparts. Notably, RA patients with memory impairment exhibited considerably higher disease activity scores with 28 joint-erythrocyte sedimentation rate (DAS28-ESR) values, in contrast to RA patients without memory impairment. Additionally, Katchamart indicated that cognitive impairment is associated with high cumulative RA disease activity. In the current study, it was observed that among RA patients with active disease, the left precuneus, left middle frontal gyrus, and right cingulate gyrus exhibited heightened activation compared to those in remission.  

The study findings suggested that precuneus hyperactivity may be a key neuroimaging indicator of visuospatial impairment in patients with RA. Additionally, the left precuneus increased activity is strongly correlated with disease activity, which could provide a new basis for the early clinical diagnosis and treatment evaluation of cognitive impairment in RA patients as well as a potential objective radiographic indicator for determining the severity of their disease. However, further in-depth research is required to confirm and fully comprehend the implications of precuneus hyperactivity in clinical settings . 


  1. Zheng Y, Xie L, Huang Z, Peng J, Huang S, Guo R, et al. Enhanced activity of the left precuneus as a predictor of visuospatial dysfunction correlates with disease activity in rheumatoid arthritis. Eur J Med Res. 2023 Aug 9;28(1):276.  
  2. Lee JH, Kim GT, Kim YK, Lee SG. Cognitive function of patients with rheumatoid arthritis is associated with disease activity but not carotid atherosclerotic changes. Clin Exp Rheumatol. 2018;36(5):856–61.  
  3. Katchamart W, Narongroeknawin P, Phutthinart N, Srinonprasert V, Muangpaisan W, Chaiamnauy S. Disease activity is associated with cognitive impairment in patients with rheumatoid arthritis. Clin Rheumatol. 2019 Jul;38(7):1851–6.