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Emotional unawareness in psoriatic arthritis: decoding the impact of alexithymia on pain perception, disease activity, and treatment response

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14

 

  1. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome; and Rheumatology Unit, Azienda Socio Sanitaria Territoriale Ovest Milanese, Internal Medicine Department, Legnano Hospital, Legnano, Milan, Italy.
  2. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  3. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  4. Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Bari, Italy.
  5. Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.
  6. Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.
  7. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  8. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  9. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  10. Rheumatology Unit, Azienda Socio Sanitaria Territoriale Ovest Milanese, Internal Medicine Department, Legnano Hospital, Legnano, Milan, Italy.
  11. Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Bari, Italy.
  12. Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II; and ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Napoli, Italy.
  13. Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Bari, Italy.
  14. Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. maria.sole.chimenti@uniroma2.it

CER20024
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PMID: 42544602 [PubMed]

Received: 10/04/2026
Accepted : 15/06/2026
In Press: 27/07/2026

Abstract

OBJECTIVES:
Psychological distress influences pain and disease severity perception among patients affected by psoriatic arthritis (PsA). Alexithymia, a personal trait characterised by the difficulty in recognising and articulating emotions, has been observed in other rheumatic diseases, but its role in PsA remains underrecognised. We investigated the prevalence of alexithymia in PsA and its association with disease activity, psychological burden, and treatment complexity.
METHODS:
A cross-sectional observational study was conducted across three Italian rheumatology centers, enrolling PsA patients on stable biological therapy. Toronto Alexithymia Scale (TAS-20), Pain Catastrophising Scale (PCS), Beck’s Depression Inventory (BDI), Widespread Pain Index (WPI), Symptom Severity Scale (SSS), alongside Disease Activity Index for PsA (DAPSA), Bath Axial Spondyloarthritis Disease Activity Index (BASDAI), and Axial Spondyloarthritis Disease Activity Index-C Reactive Protein (ASDAS-CRP) were assessed at last follow-up. Associations with alexithymia were explored by univariate analyses, Spearman correlation, and multivariable logistic regression.
RESULTS:
Among 207 PsA patients, 63 (30.4%) were classified as alexithymic (TAS≥61). Patients with alexithymia exhibited significantly higher pain-VAS, patient and physician global assessment, tender joint count, PCS, WPI+SSS, and BDI scores, as well as elevated DAPSA, BASDAI, ASDAS-CRP, while inflammatory markers and swollen joint count were similar between groups. Alexithymic patients underwent multiple biological therapy lines and reported increased conventional synthetic DMARDs and non-steroidal anti-inflammatory drug usage. A strong correlation emerged between TAS-20 and PCS, alongside female sex, concomitant fibromyalgia and higher DAPSA were independent predictors of alexithymia in multivariable model.
CONCLUSIONS:
Alexithymia is present in PsA and is linked to increased pain perception, disease activity and treatment burden.

DOI: https://doi.org/10.55563/clinexprheumatol/njdvx3

Rheumatology Article

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