Clinical Importance of Central Sensitization and Neuropathic Pain in The Treatment and Follow-Up of Patients with Psoriasis and Psoriatic Arthritis

Central sensitization syndromes and neuropathic pain are frequently associated with chronic inflammatory rheumatic diseases such as psoriasis and psoriatic arthritis (PsA). Here, we analyzed the clinical significance of central sensitization (CS) and neuropathic pain, defined as the hyperexcitability of the central nervous system, in psoriasis and PsA patients. Our study included 50 patients with psoriasis aged 45.3 ± 14.4 years, 53 PsA patients aged 41.4 ± 12.7 years, and 50 healthy control group aged 40.7 ± 13.5 years (with similar age and body mass index distribution). Visual analogue scale (VAS), psoriasis area and severity index (PASI) score, health assessment questionnaire (HAQ), minimal disease activity (MDA) scale, self-leeds assessment of neuropathic symptom and signs (S_LANNS), pain-detect questionnaire, and central sensitization inventory (CSI) were used in the study. The presence of CS was in the 68% of patients with psoriasis (N = 34), 35.8% (N = 19) of PsA patients, and 63.6% (N = 21) in control group; neuropathic pain was detected 50% of patients with psoriasis (N = 25), 60.4% (N = 32) of PsA patients, and 63.6% (N = 21) in controls. Frequencies of most common central sensitization syndromes were as follows: anxiety disorder (48%), chronic fatigue syndrome (40%), restless leg syndrome (22%), and depression (22%) in the psoriasis group and chronic fatigue syndrome (39.6%), fibromyalgia syndrome (28.3%), and irritable bowel syndrome (18.9%) in the psoriatic arthritis group. In the linear logistic regression analysis, MDA was found to be strongly related with the CS score (beta = -0.534; <i>P</i> < 0.001). Neuropathic pain and CS are frequently associated with disease activity in psoriasis and PsA patients. These chronic pain syndromes should be considered in management of these diseases.