Pain in axSpA may Reflect More than Inflammation

Hi everybody, this is Adela Castro reporting from Orlando here at ACR 2026, and I want to discuss the importance of identifying nociplastic pain in patients with axSpA.

The first abstract that I'm going to be discussing is number 1332, and it evaluated the symptom burden, disease activity, and brain connectivity in a cohort of axSpA patients. Interestingly, in this cohort, 84% of the patients did not have evidence of inflammation in spite of having high disease activity, and this highlights the importance of brain connectivity. So these findings definitely highlight the importance of altered brain connectivity in pain amplification in patients with axSpA.

On that same note, I want to present abstract 1354, which evaluated the presence and the impact of fibromyalgia symptoms in patients from an Indian cohort that also had axSpA. In this patient population they included 151 patients, out of which it was a very low prevalence for fibromyalgia syndrome. However, it still showed that in spite of evaluating the pain, it also found that patients had more worsening of their outcomes in terms of disease activity, quality of life, and symptom burden.

So definitely it's very important to keep in mind when evaluating patients with axSpA not only to evaluate their disease activity, but to take into account other components that can affect their pain, including nociplastic pain. For more, follow up with us at RheumNow.