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Hello, my name is Dr. Philip Mease and I'm here at ACR Convergence 2026.
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I'd like to tell you about one of my favorite abstracts, 1332.
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I have a real interest in the phenomenon of central sensitization pain, which is also called nociplastic pain, which typically occurs in 20 to 30% of our patients with various rheumatic diseases, including axial spondyloarthritis.
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It tends to influence the pain experience in patients, augmenting it so that even when inflammation is well controlled, it may be present.
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Mohamad Bahr at OSU has been studying this using a technique known as functional MRI imaging, which is a way of teaching us about the activity of neural networks and various brain centers that are involved in the processing of pain.
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What he found in a group of patients with axial spondyloarthritis is that a portion of them had increased activity of something called the default mode network.
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This is a neural network which in fibromyalgia patients is constantly on.
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We have learned that if the default mode network behaves more normally — that is, going through periods of time when it shuts down or
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diminishes in order to let the brain help modulate or down-regulate the pain experience — we have found that the DMN in patients with fibromyalgia
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just can't; it's always on.
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And so what he found was that this was indeed the case in a significant proportion of axial spondyloarthritis patients, and thus was consistent with
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previous literature that suggested that malfunction of the DMN — the default mode network — being constantly on contributed to the patients' pain experience.
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So they had more pain. They also had more depression, they had more sleep disturbance.
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And so recognizing this is important in order for us to augment treatment of our patients not just with immunomodulatory medicines, but also medicines that can help improve nociplastic pain, or non-medication approaches to do so.
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