Rewiring the Brain-Immune Axis for Chronic Pain Using Transcranial Magnetic Stimulation in Psoriatic Arthritis

NCT07403890 | Not Yet Recruiting

• 1 other identifier: GN25RH492
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Despite advances in immunomodulatory therapies, many Psoriatic arthritis (PsA) patients experience persistent pain unrelated to clinical active joint inflammation. Recent evidence suggests the Inferior Parietal Lobule (IPL) serves as a neuroimmune hub linking central neural activity with peripheral immune dysregulation. In a prior feasibility study, a single L-IPL-targeted TMS session reduced pain and altered immune signalling in inflammatory arthritis by reducing STAT3 phosphorylation in circulating monocytes. This study builds on those findings by evaluating whether rTMS over 4 weeks can induce sustained immune reprogramming while providing meaningful pain relief.

Conditions

Psoriatic Arthritis

Outcome Measures

Primary Outcomes (1)

• Change in STAT3 phosphorylation in circulating monocytes

  Assessment of the effect of left-inferior parietal lobule (L-IPL) targeted repetitive transcranial magnetic stimulation (rTMS) on immune systems; specifically changes in circulating monocytes intracellular signalling, primarily STAT3 phosphorylation levels, assessed via flow cytometry, before and after rTMS targeting L-IPL compared with the control (vertex stimulation) condition.

  Week 1 to Week 4

Secondary Outcomes (13)

• Changes in genetic expression of circulating immune cells, monocytes and CD8+ T-cells, using transcriptomic assays (RNA-seq).

  Week 1 to Week 4

• Changes in trained immunity set-points in monocytes and CD8+ T-cells, by investigating their epigenetic profile changes using Cleavage Under Targets and Tagmentation (CUT&TAG assay).

  Week 1 to Week 4

• Changes in pain severity as measured by the Pain Number Rating Scale.

  Week 1 to Week 4

• Changes in pain severity as measured by Widespread Pain as part of the American College of Rheumatology Fibromyalgia scale.

  Week 1 to Week 4

• Changes in putative pain confounders as measured by PROMIS-Fatigue.

  Week 1 to Week 4

Other Outcomes (7)

• Feasibility data on EQ-5D quality of life scores.

  Week 1 and Week 4

• Feasibility data on participant adherence.

  Week 0 to Week 4

• Feasibility data on TMS tolerability.

  Week 1 to Week 4

Study Arms (2)

rTMS (Left Inferior Parietal Lobule)

EXPERIMENTAL

Participants receive active repetitive transcranial magnetic stimulation (rTMS) targeted to the left inferior parietal lobule (L-IPL). Stimulation is delivered at 10 Hz, 90% resting motor threshold, 1200 pulses per session, across 12 sessions over 4 weeks. This arm is designed to evaluate whether neuromodulation of the L-IPL alters immune signalling and reduces persistent pain in psoriatic arthritis.

Device: Active Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS (Vertex Stimulation)

SHAM COMPARATOR

Participants receive control rTMS delivered to the cranial vertex, a site not expected to modulate neuroimmune pathways relevant to pain. Stimulation parameters match the active arm (10 Hz, 90% resting motor threshold, 1200 pulses per session, 12 sessions over 4 weeks). This arm controls for nonspecific effects of rTMS, including sensory experience and participant expectations.

Device: Control Repetitive Transcranial Magnetic Stimulation (rTMS)

Interventions

Active Repetitive Transcranial Magnetic Stimulation (rTMS) DEVICE

rTMS delivered to the left inferior parietal lobule at 10 Hz, 90% resting motor threshold, 1200 pulses per session, for 12 sessions over 4 weeks.

rTMS (Left Inferior Parietal Lobule)

Control Repetitive Transcranial Magnetic Stimulation (rTMS) DEVICE

rTMS delivered to the cranial vertex using identical stimulation parameters to the active arm, serving as a control condition.

rTMS (Vertex Stimulation)

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults ≥ 18 years ≤ 75 years
• Diagnosis of PsA according to CASPAR (Classification Criteria for Psoriatic Arthritis).
• Low disease activity (no more than one joint with clinically active swelling) or remission
• Chronic pain for at least 3 months and VAS (Visual Analogue Scale) pain ≥30 mm
• Stable treatment ≥3 months prior to entering the study
• Able and willing to maintain medication for the duration study
• Able to undergo MRI and TMS procedures

You may not qualify if:

• Inability to provide written informed consent.
• Severe physical impairment (e.g. blindness, deafness, paraplegia) Pregnant, planning pregnancy or breast feeding.
• Severe claustrophobia precluding MRI.
• Contraindications to MRI (e.g. metal implants/ pacemaker).
• Contraindications to TMS (e.g. history of seizures).
• Serious infection including sepsis, tuberculosis and opportunistic infections such as invasive fungal infections.
• Major confounding neurological disease including Multiple
• Sclerosis, Stroke, Traumatic Brain Injury, Parkinson's Disease, Alzheimer's Disease

Sponsors & Collaborators

• NHS Greater Glasgow and Clyde: lead
• Chief Scientist Office of the Scottish Government: collaborator

Study Sites (1)

Queen Elizabeth University Hospital

Glasgow, Scotland, G51 4TF, United Kingdom

Location

MeSH Terms

Conditions

Arthritis, Psoriatic

Condition Hierarchy (Ancestors)

Spondylarthropathies; Spondylarthritis; Spondylitis; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Arthritis; Joint Diseases; Psoriasis; Skin Diseases, Papulosquamous; Skin Diseases; Skin and Connective Tissue Diseases

Study Officials

• Flavia Sunzini, MD

  University of Glasgow

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maxine Arnott, BSc

CONTACT

07890 059695; Maxine.Arnott@glasgow.ac.uk

Neil Basu, MD

CONTACT

Neil.Basu@glasgow.ac.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Participants are masked to group allocation. The rTMS operator is not masked due to the need to position the coil at different stimulation sites.
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants are randomised 1:1 to receive either active rTMS to the left inferior parietal lobule or control rTMS to the vertex for 12 sessions over 4 weeks.

Study Record Dates

• First Submitted: January 16, 2026
• First Posted: February 11, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): March 28, 2028
• Study Completion (Estimated): March 28, 2028
• Last Updated: February 11, 2026

Record last verified: 2026-02

Locations

GB (1)