Prevalence and predictors of kinesiophobia in psoriatic arthritis: the role of central sensitization and comorbidities

Background Kinesiophobia (excessive fear of movement due to belief of injury) is highly prevalent in rheumatologic diseases, yet its prevalence and associations in psoriatic arthritis (PsA) remain unexplored. Objective To determine the prevalence of kinesiophobia in PsA and examine its associations with central sensitization (CS), demographic characteristics, disease activity, physical function, and patient-reported outcomes. Methods Cross-sectional study of 246 consecutive PsA patients. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11. CS was measured by Central Sensitization Inventory (CSI). Disease activity, functional status, physical activity, sleep quality, anxiety, depression, and fatigue were systematically evaluated. Univariate and multivariable analyses (logistic and linear regression) were performed. Results Kinesiophobia was present in 45.5% (112/246) of patients. Patients with kinesiophobia demonstrated significantly higher CSI scores (41.5 vs. 29; p < 0.001), reduced physical activity (1619.5 vs. 2,970 MET-minutes/week; p = 0.01), greater disease activity (cDAPSA: 13 vs. 11; p = 0.001), functional impairment (HAQ-DI; p = 0.001), and increased comorbid anxiety and depression ( p = 0.001). A significant correlation existed between kinesiophobia and CSI (r = 0.39; p < 0.001). In multivariable logistic regression, central sensitization (OR: 1.03; 95% CI: 1.00–1.05; p = 0.02) and sleep quality (PSQI; OR: 1.09; 95% CI: 1.00–1.1; p = 0.03) emerged as independent predictors, explaining 20% of kinesiophobia variance. In linear regression, these variables accounted for 12% of variance (R 2 = 0.12). Conclusion Kinesiophobia functions as an amplifier of pain perception and functional disability, particularly in patients with symptom-inflammation discordance. A bidirectional pathophysiologic relationship between kinesiophobia and CS likely perpetuates chronic pain and disability. Multidimensional interventions may enhance clinical outcomes in kinesiophobic PsA patients, especially those with high perceived impact despite adequate inflammatory control.