Functional MRI: exploring brain connectivity as a biomarker for inflammatory and immune-mediated diseases

Abstract Functional magnetic resonance imaging (fMRI) has emerged as a powerful neuroimaging modality for noninvasive assessment of brain activity and connectivity. It is well-established in the evaluation of numerous neurological and psychiatric conditions. Encouraged by its diagnostic advantages in these domains, there is growing interest in applying fMRI to rheumatologic disease conditions increasingly recognized to involve the central nervous system through mechanisms such as chronic pain, neuroinflammation, and dysregulation of brain-body interactions. This review summarizes recent evidence supporting the potential of fMRI to serve as a biomarker for central changes in common immune-mediated diseases. Functional alterations in brain regions involved in pain, mood, and cognition may reflect disease activity and hold promise for early diagnosis or therapeutic monitoring. Nonetheless, challenges such as signal variability, technical limitations, and a lack of standardization currently restrict clinical implementation. Further research is needed to validate fMRI biomarkers in rheumatology and to integrate them into a broader, multimodal diagnostic framework.