Metabolic Syndrome Worsens Pain Catastrophizing in Psoriatic Arthritis

New research suggests metabolic syndrome (MetS) is highly prevalent and associated with increased levels of pain catastrophizing in patients with psoriatic arthritis (PsA).1

Study findings suggest MetS negatively impacts overall pain catastrophizing, as measured by the Pain Catastrophizing Scale, as well as its individual components, including helplessness, rumination, and magnification.1

A type of arthritis that typically affects people with psoriasis or a biological family history of psoriasis, PsA has been linked to an increased likelihood of developing other health conditions, including cardiovascular disease, obesity, hypertension, dyslipidemia, and MetS.2

“To our knowledge, the association between pain catastrophizing and MetS in PsA has never been investigated,” Damiano Currado, MD, an immunoreumatology specialist at Campus Bio-Medico University Hospital Foundation in Rome, and colleagues wrote.1

To address this gap in research, investigators conducted a single-center, observational study including patients with PsA seen at the Arthritis Center at the Rheumatology Clinic of Fondazione Policlinico Campus Bio-Medico of Rome.1

Consecutive outpatients > 18 years of age who met the Classification Criteria for Psoriatic Arthritis (CASPAR) were enrolled from November 2023 to June 2024. Participants fulfilling the US National Cholesterol Education Program Adult Treatment Panel III (NCEP-ACT III) criteria were classified as having MeTs.1

At baseline, the following PsA disease activity scores were collected:

• Disease Activity for Psoriatic Arthritis (DAPSA)
• Minimal disease activity (MDA)
• Very low disease activity (VLDA)
• Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
• Psoriasis Area Severity Index (PASI)
• Leeds Enthesitis Index (LEI)

Investigators assessed pain catastrophizing, including helplessness, rumination and magnification, through the PCS.1

In total, the study enrolled 170 patients with PsA. Among the cohort, the median age was 58 (53–64) years, the majority (66.4%) of participants were female, and the media disease duration was 72 (25-132) months. According to NCEP-ACT III criteria, 42.94% of patients were classified as having MetS.1

The median DAPSA value among the cohort was 12.5 (4.07–22) and the median BASDAI score was 5.1 (2.4–7.1). MDA and VLDA criteria were achieved by 37.58% and 17.37% of participants, respectively.1

Investigators observed a PCS median value of 18 (6–32). Regarding its domains, the helplessness median value was 7 (2–14), the rumination median value was 7 (2–13.5), and the magnification median value was 3 (1–5).1

Univariable analysis revealed a positive association between PCS and female sex (b = 8.61; 95% CI, 4.02-13.2; P <.001), DAPSA values (b = 0.78; 95% CI, 0.58-0.97; P <.001), diagnosis of fibromyalgia (b = 12.24; 95% CI, 8-16.48; P <.001), and presence of MetS (b = 13.96; 95% CI, 9.94-17.98; P <.001).1

After adjusting for age, sex, fibromyalgia, and DAPSA disease activity, multivariable linear regression analysis showed a significant association between PCS and MetS (b = 8.84; 95% CI, 4.66-13.02; P <.0001), and between PCS and DAPSA (b = 0.55; 95% CI, 0.34-0.77; P <.0001).1

“The higher prevalence of MetS in patients with PsA and its association with a higher PC negatively impacting the achievement of disease remission or low disease activity suggests that a multidisciplinary approach is strongly needed,” investigators concluded.1 “Interventions targeting both metabolic health and psychological well-being, such as lifestyle modifications, pharmacological treatments, and cognitive-behavioral therapy, could potentially improve the management of patients with PsA affected by MetS.”

References

1. Currado D, Berardicurti O, Saracino F, et al. The Relationship Between Metabolic Syndrome and Pain Catastrophizing in Psoriatic Arthritis. Rheumatol Ther (2025). https://doi.org/10.1007/s40744-025-00758-6

2. National Psoriasis Foundation. Related Conditions of Psoriatic Arthritis. February 3, 2025. Accessed April 28, 2025. https://www.psoriasis.org/psa-related-conditions/