
Brain-focused genes emerge as key drivers of fibromyalgia in a 2.5 million-person study
A multi-ancestry GWAS meta-analysis of 2.56 million individuals (54,629 cases; 2,509,126 controls) identified 26 fibromyalgia risk loci, led by a coding HTT variant; neural genes such as DCC, DRD2/NCAM1, MDGA2 and CELF4 highlight brain pathways as central to fibromyalgia. Heritability is enriched in brain tissues and neurons, with dentate gyrus neurons showing the strongest signal, supporting a CNS basis and possible gut–brain interactions via enteric neurons. Genetic correlations show widespread pleiotropy with chronic pain, psychiatric and metabolic traits, notably pain syndromes and PTSD. The genetic architecture is nearly identical in males and females, despite prevalence differences. Polygenic risk scores have modest predictive value (highest AUC ~0.59 in Europeans) and can stratify risk. Therapeutic implications include HTT/GPR52 and CELF4 targets, arguing against a primary autoimmune etiology. Limitations include predominantly European ancestry and ICD-based phenotyping; replication in diverse groups is needed. Overall, findings map fibromyalgia to central nervous system biology and provide molecular entry points for future research.












