[Correspondence] From whole-brain metrics to circuit-specific precision: advancing fMRI biomarkers for TNF inhibitor response in rheumatoid arthritis

The landmark study by Hess and colleagues1 represents a paradigm shift in rheumatoid arthritis therapeutics by positioning the CNS as a key predictor of TNF inhibitor response. The authors' randomised trial compellingly shows that patients with high baseline functional MRI (fMRI)-measured CNS pain activation have substantially better clinical outcomes with certolizumab pegol than individuals with low activation. This work challenges the peripheral–centric view of rheumatoid arthritis, reframing subjective symptoms such as pain as active therapeutic targets rather than mere byproducts of joint inflammation.