The Relationship Between Metabolic Syndrome and Pain Catastrophizing in Psoriatic Arthritis

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Abstract
Introduction: Psoriatic arthritis (PsA) is a complex inflammatory disease often associated with metabolic syndrome (MetS). It has been demonstrated that pain catastrophizing (PC), characterized by an exaggerated negative cognitive and emotional response to actual or anticipated pain, impacts the achievement of remission and therapy discontinuation in patients with PsA. In this study, we evaluate the potential role of MetS, the most prevalent comorbidity in PsA, in influencing PC in patients with PsA. Methods: We conducted a cross-sectional, observational study on 170 patients with PsA who met the Classification Criteria for PsA and MetS criteria. Data on disease activity, PC, and comorbidities were collected and analyzed using univariable and multivariable regressions. Results: Our results indicate a significant association between MetS and elevated PC levels in patients with PsA. Univariable analysis identified female gender, fibromyalgia, and higher Disease Activity for Psoriatic Arthritis (DAPSA) scores as factors associated with increased PC. Multivariable analysis, adjusted for age, sex, fibromyalgia, and DAPSA, confirmed that MetS independently correlates with higher PC levels (b = 8.84, 95% CI 4.66–13.02, p < 0.0001) and its domains (helplessness, rumination, magnification). Conclusions: These findings suggest that MetS significantly impacts PC in PsA, underscoring the need for a multidisciplinary approach to patient management. This study highlights the importance of addressing MetS to reduce pain catastrophizing and enhance disease management in PsA.

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