The Role of Central Sensitization and Emotional Comorbidities in Temporomandibular Involvement Among Patients with Psoriatic Arthritis

BACKGROUND: Temporomandibular disorders (TMDs) are frequently underdiagnosed in patients with psoriatic arthritis (PsA), and the mechanisms underlying their development remain poorly understood. While inflammatory processes may contribute, central pain sensitization and psychological factors could play a significant role in TMD pathogenesis. OBJECTIVE: The objectives of this study were to evaluate clinical characteristics, disease activity, psychiatric comorbidities, and pain processing mechanisms in PsA patients with and without TMD and to identify factors independently associated with temporomandibular involvement. METHODS: This cross-sectional observational study included 190 consecutive PsA patients (CASPAR criteria) from a single tertiary center. Patients with fibromyalgia were excluded. TMD was assessed by maxillofacial specialists. Disease activity (cDAPSA), functional status (HAQ-DI), disease impact (PsAID-12), central sensitization (Central Sensitization Inventory, CSI), kinesiophobia (Tampa Scale for Kinesiophobia, TSK-11), pressure pain threshold (algometry), and emotional comorbidities (Hospital Anxiety and Depression Scale, HADS) were evaluated. An exploratory binary logistic regression identified a factor independently associated with TMD. RESULTS: = 0.48). CONCLUSION: TMD in PsA is associated with central sensitization and anxiety rather than mechanisms secondary to bone damage. These findings support a multidimensional approach incorporating screening for central sensitization and psychiatric comorbidities in PsA patients with temporomandibular symptoms.