PO:01:005 | Exploring the relationship between alexithymia, pain perception, and disease burden in a cohort of patients with psoriatic arthritis

Michelina Turri¹, Eugenio Capparelli¹, Sergio Del Vescovo², Maria Iacovantuono¹, Benedetta Monosi¹, Giulia Mori¹, Ilaria Cristiano¹, Paola Conigliaro¹, Elisabetta Greco¹, Giuseppe Lopalco², Maria Sole Chimenti¹. | ¹Reumatologia, Allergologia e Immunologia Clinica, Dipartimento di Medicina dei Sistemi, Università di, Roma, Tor Vergata, Roma, Italy; ²Dipartimento di Medicina di Precisione e Rigenerativa e Area Ionica ^DiMePRe-J, Università di Bari, Bari, Italy.

Background. Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects joints and periarticular structures. It is well established that PsA exerts a significant negative impact on quality of life of affected individuals, inducing functional impairment and related disability. Joint pain and stiffness may be misinterpreted or exaggerated by PsA patients, ultimately leading to unsuccessful chances of remission. We aimed to evaluate the potential impact of alexithymia and pain catastrophizing on clinical features, disease activity and comorbidities in PsA.

Methods. A total of 166 PsA patients, fulfilling the 2006 CASPAR criteria, were enrolled. Time frame spanned from January to December 2024. The 20-item Toronto Alexithymia Scale (TAS-20) questionnaire along with Pain catastrophizing scale (PCS) were administered to all recruited patients. Clinical and demographic characteristics, along with disease activity measures, inflammatory indices and concomitant presence of fibromyalgia were recorded. Quality of life was assessed via the SF-36 questionnaire. Statistical analysis employed chi-square and T student tests, as well as Rho Spearman for correlation analysis. A statistical p<0.05 was considered significant.

Results. We divided patients into remission-LDA (DAPSA<14) and MoDA-HDA (DAPSA>14) and compared the two groups. Significant differences were noted among groups regarding diagnostic delay (31.7±41 vs 61.8±64.5 months, p<0.001) and comorbidities burden (e.g. dyslipidaemia 32 vs 33±50, p 0.020; osteoporosis 13 vs 18±27.3, p 0.021; anxiety/depression 6 vs 13±19.7, p 0.007). As expected MoDA-HDA group exhibited a greater prevalence of bDMARDs changes and more csDMARDs and NSAID/COXIB usage. We also found a significant difference between the two groups in the clinical domains, like enthesitis (n 55 vs 53±80.3, p <0.001) and dactylitis (18 vs 23±34.8, p 0.014) (Table 1). Other significant differences were found in laboratory indices (e.g. CRP (mg/dl) 0.6±0.8 vs 1.8±2.7, p <0.001), TAS total score (42.5±16.9 vs 62.7±16.7, p <0.001), Beck’s Depression Inventory (6.7±3.1 vs 12.9±9.2 vs, p <0.001), and for all items of the Short Form Health Survey 36 (SF-36) (Table 2). Within the Rho correlation analysis, strong correlations emerged in the TAS total score (Pain Catastrophizing Scale Total: Rho 0.7439; PCS rumination: Rho 0.663; PCS magnification: Rho 0.712; PCS helplessness: Rho 0.666; WPI+SSS: Rho 0.698; WPI: Rho 0.630) (Table 3).

Conclusions. This study suggests that disease activity is related to a higher disease burden including indirect index of mood disorders. The assessment of alexithymia should be an integral part of the comprehensive management of PsA patients and it might have an impact on disease activity score evaluation. Being aware of these hurdles could guide the clinician in the correct diagnostic-therapeutic framework.