Annalisa Marino

Objective: Pain in psoriatic arthritis (PsA) is multifactorial and may persist despite apparently controlled inflammatory activity. Metabolic syndrome (MetS), a frequent comorbidity in PsA, could contribute to increased pain burden beyond inflammatory disease activity. The objective was to investigate the association between MetS and pain burden in PsA, focusing on pain intensity (BPI severity; primary outcome) and pain-related functional impact (BPI interference; secondary outcome), and to assess whether these associations are independent of disease activity (DAPSA) and fibromyalgia. Methods: PSABRAIN is a cross-sectional, monocentric study including consecutive adult patients with PsA (CASPAR criteria). MetS was defined according to modified ATP III criteria. Pain outcomes were assessed using the Brief Pain Inventory (BPI) severity and interference subscales. Group comparisons (MetS vs. no MetS) were performed using appropriate parametric/non-parametric tests. Univariable and multivariable linear regression models were fitted for BPI severity and BPI interference. Multivariable models were adjusted for age, sex, disease duration, fibromyalgia, and DAPSA. Robustness analyses replaced MetS with BMI (continuous), obesity, and overweight. Results: A total of 187 PsA patients were included (44 with MetS; 143 without). MetS patients were older (median 62 vs. 57 years, p = 0.0017), had higher BMI (median 30.1 vs. 25.5 kg/m², p < 0.001) and a higher prevalence of obesity (56.8% vs. 15.4%, p < 0.001), while DAPSA did not differ between groups (p = 0.819). MetS patients reported higher BPI severity (median 5.75 vs. 4.5, p = 0.038) and BPI interference (median 6.86 vs. 5.5, p = 0.044). In univariable regression, MetS was associated with higher BPI severity (β = 0.93, 95% CI 0.08 to 1.77; p = 0.032) but not with BPI interference (β = 0.81, 95% CI −0.13 to 1.75; p = 0.091). In adjusted models, MetS remained independently associated with BPI severity (β = 0.99, 95% CI 0.23 to 1.75; p = 0.011), whereas its association with BPI interference was not significant (β = 0.69, 95% CI −0.20 to 1.57; p = 0.126). In alternative models, BMI and obesity were independently associated with both outcomes (BPI severity: BMI β = 0.097/kg/m², p = 0.004; obesity β = 0.91, p = 0.010; BPI interference: BMI β = 0.095/kg/m², p = 0.015; obesity β = 1.22, p = 0.003). Conclusions: In PsA, MetS is independently associated with higher pain severity but not with pain interference after adjustment for disease activity and fibromyalgia. Adiposity measures show consistent independent associations, particularly with pain interference, supporting the relevance of metabolic and weight-related factors in the multidimensional assessment of pain in PsA.

Background: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. Alexithymia—difficulty identifying and describing emotions—has been reported in up to 48% of FM patients and is associated with increased psychological distress and pain intensity, yet its specific contribution to FM remains unclear. Objectives: This study aimed to assess the interplay among alexithymia, self-compassion, pain catastrophizing, and hope to inform future integrated and emotion-focused treatment strategies for FM. Design: We conducted a cross-sectional investigation, consecutively recruiting 112 Caucasian women meeting the 2016 American College of Rheumatology criteria for FM between October 2023 and June 2024. Methods: Socio-demographic, clinical, and psychometric data were collected at baseline. Disease burden was evaluated using the Widespread Pain Index, Symptom Severity Scale (SSS), Polysymptomatic Distress Scale, modified Fibromyalgia Assessment Scale, and revised Fibromyalgia Impact Questionnaire (FIQ-R). Psychological constructs were assessed using the Toronto Alexithymia Scale (TAS-20), Adult Hope Scale, Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Self-Compassion Scale (SCS). Participants were stratified into non-alexithymic, borderline, and alexithymic groups according to TAS-20 thresholds. Group differences were analyzed through χ ² or Kruskal–Wallis tests, and associations were examined using univariable and multivariable linear regression models (α = 0.05). Results: Alexithymic traits were identified in 51.8% of patients. Individuals with alexithymia exhibited significantly higher anxiety, depression, and total HADS scores (all p < 0.01), greater pain catastrophizing ( p = 0.003), and lower levels of hope ( p < 0.05). Two self-compassion components, self-judgment and overidentification, were also significantly impaired ( p = 0.012). Univariable analyses showed that alexithymia was positively associated with FM severity indices (SSS, FIQ-R) and psychological distress and negatively associated with hope and several self-compassion domains (all p < 0.001). In multivariable models, SSS ( p < 0.001), PCS-Helplessness ( p = 0.005), and SCS-Overidentification ( p = 0.020) emerged as significant independent associated variables. Conclusion: Alexithymia represents a prominent marker of emotional vulnerability in FM, closely linked to symptom severity, maladaptive pain coping, and reduced hope and self-compassion. Integrating these constructs into FM assessment and management may support more comprehensive, emotion-focused therapeutic approaches.

Background/Objectives: Psoriasis (PsO) is a chronic immune-mediated disease associated with a substantial multidimensional burden extending beyond skin involvement. Sleep disturbance represents an important yet underexplored domain of patient-reported outcomes. This study aimed to investigate the relationship between PsO disease activity and sleep quality, focusing on specific sleep domains, and to evaluate whether disease severity independently predicts sleep latency and daytime dysfunction. Methods: We conducted a cross-sectional study including 136 consecutive patients with PsO from two Italian centers. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), while quality of life was measured by the SF-36. Patients were stratified according to disease severity (PASI < 10 vs. ≥10). Associations between disease activity and sleep domains were analyzed using univariable and multivariable ordinal regression models adjusted for demographic and clinical variables. Results: The study population had predominantly low disease activity (median PASI 2). The median global PSQI score was 5, indicating overall borderline sleep impairment. Patients with PASI ≥ 10 showed significantly worse sleep latency (p = 0.01) and greater daytime dysfunction (p = 0.02), while no significant differences were observed in global PSQI scores. In multivariable analyses, PASI ≥ 10 remained independently associated with increased sleep latency (β = 0.95, 95% CI 0.08–1.82; p = 0.032) and daytime dysfunction (β = 2.52, 95% CI 1.31–3.73; p < 0.001), after adjustment for confounders. Conclusions: Higher PsO disease activity is independently associated with impairment in specific sleep domains, particularly sleep latency and daytime dysfunction, rather than global sleep quality. These findings highlight the importance of assessing domain-specific sleep disturbances and support the integration of sleep outcomes into a holistic, patient-centered approach to PsO management.

Physical activity is central to spondyloarthritis (SpA) management, yet many patients avoid movement due to fear of pain and negative beliefs about exercise. The relationships between fear-avoidance beliefs, disease activity, pain catastrophising, and quality of life remain unclear. This study aimed to assess the prevalence and determinants of fear-avoidance beliefs related to physical activity in patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and to identify associated clinical, demographic, and psychological factors. This monocentric observational study enrolled 159 consecutive patients (70 axSpA, 89 PsA) attending the Rheumatology Unit of Campus Bio-Medico University Hospital. Physical activity avoidance beliefs were assessed with the FABQ-PA (scores ≥15 = high avoidance). Disease activity, quality of life, pain catastrophising, and anxiety/depression were recorded. Group comparisons, Spearman correlations, and uni-/multivariable logistic regression were performed. High physical activity avoidance was observed in 31.4% of the cohort (32.9% axSpA, 30.3% PsA). In axSpA, FABQ-PA ≥15 was associated with higher disease activity, greater PC and poorer SF-36 scores. In multivariable models, BASDAI remained significantly associated with high avoidance, with magnification retaining a weaker independent association, whereas SF-36 and other psychometric variables lost significance. In PsA, FABQ-PA was not associated with BASDAI or DAPSA. High avoidance was independently linked to female sex, higher level of helplessness and rumination, and lower SF-36, PhCS, and MCS scores, even after adjusting for disease activity. Physical activity avoidance in SpA reflects distinct but overlapping pathways. In axSpA, avoidance is predominantly associated with inflammatory disease activity, whereas in PsA it is more closely associated with psychological and quality-of-life-related factors.

Background: Anti-synthetase Syndrome (ASyS) is an idiopathic inflammatory myopathy characterized by muscle weakness and inflammatory infiltrates in muscles. Sjogren’s disease (SD) is an autoimmune condition primarily affecting exocrine glands. Both these conditions may present lung involvement. We describe a female patient with anti-synthetase/SD overlap syndrome and review the literature to identify published cases describing this overlap, aiming to better define its clinical, radiological, and serological features. Methods: The case description was based on a retrospective collection of clinical, laboratory, and imaging data related to the patient’s diagnostic process and clinical course. Data were anonymized and handled in accordance with the competent territorial Ethics Committee. A literature review was performed using the MEDLINE and Scopus databases by combining the keywords “Anti-Synthetase syndrome”, “Sjögren disease”, “Sjögren syndrome”, “Myositis”, and “Interstitial lung disease” (ILD). Published cases were selected if they met the 2016 EULAR/ACR criteria for SD and at least one of the currently proposed classification criteria for ASyS. Results: The described case concerns a 68-year-old woman with rapidly progressive ILD. The diagnosis of anti-synthetase/SD overlap syndrome was based on clinical, serological (anti-Ro52 and anti-PL7 antibodies), histological, and radiological findings. Despite immunosuppressive and antifibrotic treatment, the clinical course worsened, leading to a poor outcome. In addition, six relevant cases were identified in the literature. Clinical presentations, autoantibody profiles, radiological findings, and outcomes were highly heterogeneous. Among the reported cases, no standardized treatment protocols were adopted, reflecting the lack of consensus in managing this rare condition. Conclusions: In anti-synthetase/SD overlap syndrome, ILD may follow a rapidly progressive course. Early recognition can be challenging, especially in the absence of muscular involvement. This case-based review highlights the need for more standardized approaches to the diagnosis and management of this rare and complex overlap syndrome.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that significantly impacts quality of life, particularly among women. Previous studies have suggested that oral contraceptive (OC) use may influence RA risk, but conflicting findings from earlier meta-analyses necessitate an updated analysis incorporating more recent data. Methods: We conducted a systematic review and meta-analysis of observational studies on OC use and RA risk by searching MedLine (via PubMed), Scopus, and Cochrane Databases up to September 2024. Results: Our analysis demonstrated that current or prior use of OCs is associated with a statistically significant reduction in RA risk (OR 0.80, 95% CI 0.70–0.91). In contrast, the associations for current use (OR 0.59, 95% CI 0.34–1.02) and past use (OR 0.83, 95% CI 0.69–1.01) were less definitive, likely due to substantial heterogeneity among studies. Cumulative meta-analysis revealed a modest temporal trend toward a protective effect of OC use. Conclusions: This meta-analysis supports a protective association between current or prior OC use and the development of RA, highlighting the potential role of hormonal factors in RA pathogenesis.

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.

Background: Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are inflammatory diseases with shared genetic backgrounds and clinical comorbidities. Headache, a common global health issue, affects over 50% of adults and encompasses various types, including migraine, tension-type, and cluster headaches. Migraine, the most prevalent, recurrent, and disabling type, is often associated with other medical conditions such as depression, epilepsy, and psoriasis, but little is known about the relationship between autoimmune disease and the risk of migraine. Methods: A cross-sectional study was conducted from July to November 2022, enrolling 286 participants, including 216 with PsA, 70 with axSpA, and 87 healthy controls. Results: Headache prevalence was significantly higher in the PsA (39.81%) and axSpA (45.71%) patients compared to the healthy controls. The prevalence of migraine without aura was also significantly higher in both the PsA (18.52%) and axSpA (28.57%) groups compared to the healthy controls. Conclusions: These findings underscore the high burden of headache and migraine in PsA and axSpA participants, highlighting the need for improved management and treatment strategies for these patients.