The Nocebo Effect in Rheumatology: An Unexplored Issue

Area of Science:

• Rheumatology
• Neuroscience
• Pharmacology

Background:

• The nocebo effect, a negative response to a placebo, is well-documented in healthy volunteers and other medical fields.
• Its specific impact on patients with inflammatory rheumatic diseases transitioning to biosimilars requires further investigation.
• Nocebo responses may contribute to perceived or actual treatment failures after switching from originator biologics to biosimilars.

Purpose of the Study:

• To describe the features of the nocebo effect.
• To explore its potential impact on biosimilar transition studies in inflammatory rheumatic diseases.
• To highlight the need for further research into nocebo pathophysiology and diagnosis in this patient population.

Main Methods:

• Review of existing literature on nocebo effects in various medical fields.
• Discussion of potential mechanisms and diagnostic challenges.
• Identification of knowledge gaps regarding nocebo in rheumatology.

Main Results:

• Nocebo response involves specific cerebral areas and neurotransmitter pathways.
• Nocebo may account for some biosimilar treatment failures in rheumatic diseases.
• Current diagnostic criteria and specific studies for nocebo in this context are lacking.

Conclusions:

• The diagnosis of nocebo effect in rheumatic disease patients switching to biosimilars currently relies on individual clinician assessment.
• Validated criteria, neurochemical, and neuroimaging studies are needed to confirm nocebo's impact.
• Understanding nocebo is crucial for accurately evaluating biosimilar efficacy and safety in rheumatology.