Neurobiologic features of fibromyalgia are also present among rheumatoid arthritis patients

Basu, N. , Kaplan, C. M., Ichesco, E., Larkin, T., Harris, R. E., Murray, A., Waiter, G. and Clauw, D. J. (2018) Neurobiologic features of fibromyalgia are also present among rheumatoid arthritis patients. Arthritis and Rheumatology, 70(7), pp. 1000-1007. (doi:10.1002/art.40451) (PMID:29439291)

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Abstract

Objective: Many patients with rheumatoid arthritis (RA) report pain despite excellent control of inflammation with immunotherapies. Variable degrees of coexisting fibromyalgia (FM) may explain this disparity. FM has been characterized by aberrant brain functional connectivity, especially between the default mode network (DMN) and insula. We undertook this study to test the hypothesis that RA patients with the highest 2011 American College of Rheumatology FM survey criteria scores—a continuous measure of the degree of FM also known as “fibromyalgianess” (FMness)—would demonstrate functional connectivity abnormalities similar to those in FM. Methods: RA patients underwent an 11‐minute functional connectivity magnetic resonance imaging (MRI) brain scan and a clinical evaluation which included a measure of FMness. Brain networks were isolated from functional connectivity MRI data. Individual patient network‐to–whole brain connectivity analyses were then conducted, followed by group‐level regression, which correlated the connectivity of each network with FMness. Results were significant on the cluster level with a family‐wise error (FWE) rate P value less than 0.05 derived from an uncorrected voxel‐level P value less than 0.001. Results: A total of 54 patients participated (mean age 54.9 years, 75.9% women, mean FMness score 13.2 [range 1–29]). From the whole brain analyses, a single significant positive correlation between DMN connectivity to the left mid/posterior insula and FMness (r = 0.58, FWE‐corrected P = 0.001) was demonstrated. Conclusion: RA patients who have increased levels of FMness appear to share neurobiologic features consistently observed in FM patients. This study is the first to provide neuroimaging evidence that RA is a mixed pain state, with many patients’ symptoms being related to the central nervous system rather than to classic inflammatory mechanisms.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Basu, Dr Neil
Authors: Basu, N., Kaplan, C. M., Ichesco, E., Larkin, T., Harris, R. E., Murray, A., Waiter, G., and Clauw, D. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Arthritis and Rheumatology
Publisher:Wiley
ISSN:2326-5191
ISSN (Online):2326-5205
Published Online:14 February 2018
Copyright Holders:Copyright © 2018 American College of Rheumatology
First Published:First published in Arthritis and Rheumatology 70(7):1000-1007
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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