OBJECTIVE Rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) exhibit alterations in brain connectivity synonymous with central sensitization. This study was undertaken to investigate how peripheral inflammation, the principal nociceptive stimulus in RA, interacts with brain connectivity in RA patients with FM. METHODS RA patients with concomitant FM and those without FM (FM+ and FM-, respectively; n = 27 per group) underwent functional connectivity magnetic resonance imaging. Seed-to-whole-brain functional connectivity analyses were conducted using seeds from the left mid/posterior insula and left inferior parietal lobule (IPL), which are regions that have been previously linked to FM symptoms and inflammation, respectively. The association between functional connectivity and erythrocyte sedimentation rate (ESR) was assessed in each group separately, followed by post hoc analyses to test for interaction effects. Cluster-level, family-wise error (FWE) rates were considered significant if the P value was less than 0.05. RESULTS The group of RA patients with FM and those without FM did not differ by age, sex, or ESR (P > 0.2). In FM+ RA patients, increased functional connectivity of the insula-left IPL, left IPL-dorsal anterior cingulate, and left IPL-medial prefrontal cortex regions correlated with higher levels of ESR (all FWE-corrected P < 0.05). Post hoc interaction analyses largely confirmed the relationship between ESR and connectivity changes as FM scores increased. CONCLUSION We report the first neurobiologic evidence that FM in RA may be linked to peripheral inflammation via pronociceptive patterns of brain connectivity. In patients with such "bottom-up" pain centralization, concomitant symptoms may partially respond to antiinflammatory treatments.

中文翻译：

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类风湿性关节炎伴发纤维肌痛的患者炎症反应与感觉感受性脑连接的关系。

目的类风湿性关节炎（RA）伴有纤维肌痛（FM）的患者表现出大脑中枢性连接改变，与中枢敏化同义。这项研究的目的是调查RA FM的外周血炎症（RA中主要的伤害感受刺激）与大脑的连通性如何相互作用。方法伴有FM和无FM的RA患者（分别为FM +和FM-；每组n = 27）接受功能连接磁共振成像。种子到全脑的功能连通性分析是使用来自左中/后岛突和左下顶叶（IPL）的种子进行的，这些种子先前分别与FM症状和炎症相关。在每个组中分别评估功能连接性和红细胞沉降率（ESR）之间的关联，然后进行事后分析以测试相互作用的影响。如果P值小于0.05，则认为群集水平的家庭错误率（FWE）较高。结果患有FM的RA患者和没有FM的RA患者在年龄，性别或ESR方面均无差异（P> 0.2）。在FM + RA患者中，岛上左IPL，左IPL背前扣带和左IPL内侧前额叶皮层区域的功能连接性增强与ESR升高相关（所有FWE校正后的P <0.05）。事后交互分析很大程度上证实了随着FM得分的提高，ESR与连接性变化之间的关系。结论我们报告了第一个神经生物学证据，即RA中的FM可能通过脑部连接的伤害感受模式与周围炎症相关。在具有这种“自下而上”疼痛集中的患者中，伴随的症状可能对抗炎治疗产生部分反应。