Evidence map›Paper›PMID 40165287›Full record

ArticleArthritis research & therapy2025

The insula represents a key neurobiological pain hub in psoriatic arthritis.

Flavia Sunzini, Kristian Stefanov, Salim Al-Wasity, Chelsea Kaplan, Andrew Schrepf, Noah Waller, Steven Harte, Richard Harris, Daniel J Clauw, John McLean and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Arthritis research & therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Flavia SunziniSchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK. flavia.sunzini@glasgow.ac.uk.ORCID 0000-0003-0775-9960
Kristian StefanovSchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK. kristian.stefanov@glasgow.ac.uk.ORCID 0000-0003-0117-1744
Salim Al-WasitySchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK.
Chelsea KaplanChronic Pain and Fatigue Research Centre, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Andrew SchrepfChronic Pain and Fatigue Research Centre, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Noah WallerChronic Pain and Fatigue Research Centre, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Steven HarteChronic Pain and Fatigue Research Centre, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
Richard HarrisSusan Samueli Integrative Health Institute, School of Medicine, University of California at Irvine, Irvine, CA, USA.
Daniel J ClauwChronic Pain and Fatigue Research Centre, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
John McLeanDepartment of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK.
Stefan SiebertSchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK.
Carl S GoodyearSchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK.
Gordon D WaiterAberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK.
Neil BasuSchool of Infection & Immunity, University of Glasgow, Glasgow, Scotland, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPain remains a principal complaint for people with psoriatic arthritis (PsA), despite successful mitigation of inflammation. This situation alludes to the co-existence of distinct pain mechanisms. Nociceptive and nociplastic mechanisms are clinically challenging to distinguish. Advances in brain functional magnetic resonance imaging (fMRI) have successfully characterised distinct pain mechanisms across several disorders, in particular implicating the insula. This is the first study to characterise neurobiological markers of pain mechanisms in PsA employing fMRI.

methodsPsA participants underwent a 6-minutes resting-state fMRI brain scan, and questionnaire assessments of nociplastic pain (2011 ACR fibromyalgia criteria) and body pain, assessed using the Numeric Rating Scale (NRS, 0-100). Functional connectivity between insula seeds (anterior, mid, posterior), and the whole brain was correlated with the above pain outcomes correcting for age and sex, and false discovery rate (FDR) for multiple comparisons.

resultsA total of 46 participants were included (age 49 ± 11.2; 52% female; FM score 12.5 ± 5.7; overall pain 34.8 ± 23.5). PsA participants with higher fibromyalgia scores displayed increased connectivity between: (1) right anterior insula to DMN (P < 0.05), (2) right mid and left posterior insula to parahippocampal gyri (P < 0.01 FDR); and (3) right mid insula to left frontal pole (P = 0.001 FDR). Overall pain was correlated with connectivity of left posterior insula to classical nociceptive regions, including thalamus (P = 0.01 FDR) and brainstem (P = 0.002 FDR).

conclusionFor the first time, we demonstrate objectively that nociceptive and nociplastic pain mechanisms co-exist in PsA. PsA pain cannot be assumed to be only nociceptive in origin and screening for nociplastic pain in the future will inform supplementary analgesic approaches.

Indexed as

Arthritis, PsoriaticInsular CortexPainAdultFemaleFibromyalgiaHumansMagnetic Resonance ImagingMaleMiddle AgedPain MeasurementChronic painFibromyalgiaInsulaNeuroimagingPsoriatic arthritis

Identifiers

PMID40165287
PMCPMC11956455

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.