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Published on: October 16, 2016
Neurobiologic Features of Fibromyalgia Are Also Present Among Rheumatoid Arthritis Patients
Neil Basu1, Chelsea M Kaplan2, Eric Ichesco2
1University of Aberdeen, Aberdeen, UK.
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.
Insights
Rheumatoid arthritis patients with higher fibromyalgia levels show altered brain connectivity, suggesting central nervous system involvement in their pain. This neuroimaging study highlights RA as a mixed pain state beyond inflammation.
Area of Science:
- Neuroimaging
- Rheumatology
- Pain Medicine
Background:
- Rheumatoid arthritis (RA) patients often experience pain despite controlled inflammation.
- Fibromyalgia (FM) is associated with altered brain functional connectivity, particularly involving the default mode network (DMN) and insula.
- The degree of FM symptoms in RA patients, termed 'fibromyalgianess' (FMness), may explain persistent pain.
Purpose of the Study:
- To investigate if RA patients with higher FMness scores exhibit brain functional connectivity abnormalities similar to those seen in FM.
- To test the hypothesis that increased FMness in RA is linked to aberrant DMN-insula connectivity.
Main Methods:
- Functional connectivity magnetic resonance imaging (MRI) was performed on 54 RA patients.
- Clinical evaluation included a measure of FMness (2011 ACR FM survey criteria).
- Group-level regression analyzed the correlation between brain network connectivity and FMness scores, with significance set at FWE-corrected P < 0.05.
Main Results:
- A significant positive correlation was found between DMN connectivity to the left mid/posterior insula and FMness (r = 0.58, P = 0.001).
- This suggests that higher FMness in RA is associated with specific patterns of brain connectivity.
Conclusions:
- RA patients with elevated FMness share neurobiological features with FM patients.
- This study provides neuroimaging evidence that RA can be a mixed pain state, with central nervous system mechanisms contributing to symptoms.
- Pain in some RA patients may stem from central nervous system alterations rather than solely inflammatory processes.
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