Background/Purpose: Pain remains a major burden in psoriatic arthritis (PsA), often persisting despite effective control of synovial inflammation. This persistent pain may prevent patients from achieving remission or meaningful improvements in quality of life (QoL). Although pain severity is typically emphasized in clinical evaluation, emerging evidence suggests that psychological contributors—particularly maladaptive cognitive-emotional processes such as pain catastrophizing—may play a critical, underrecognized role. Pain catastrophizing, defined by magnification of symptoms, ruminative thoughts, and a sense of helplessness, is well documented in other chronic pain conditions but remains poorly characterized in PsA. In this study, we assess the prevalence and impact of pain catastrophizing in a real-world PsA population at the NYU Psoriatic Arthritis Center (PAC).

Methods: Consecutive patients meeting CASPAR criteria were enrolled at the NYU PAC into a cross-sectional study of pain and psychosocial features. Participants completed the Pain Catastrophizing Scale (PCS), which includes three subscores (helplessness, magnification, rumination); a total score >30 was considered clinically significant. Depression was defined by PHQ-9 ≥10. Pain severity was rated on a 0–10 scale. Outcomes included Minimal Disease Activity (MDA), low disease activity per cDAPSA (≤13), and multiple QoL indices (EQ-5D, PROMIS-29). Associations between PCS and disease outcomes were assessed via logistic and linear regression, adjusting for pain intensity, depression, and sex.

Results: Among 91 PsA patients, 5 (5.5%) patients met criteria for clinically significant (PCS >30), all of whom were women. Subscale symptom prevalence included helplessness (6), magnification (12), and rumination (3). Higher PCS scores were associated with reduced odds of achieving cDAPSA low disease activity (OR 0.95, 95%CI 0.90–0.99, p=0.022), and a trend toward lower MDA rates (OR 0.95, CI 0.91–1.00, p=0.060). Catastrophizing was associated with poorer QoL (EQ-5D index b=-0.009 95%CI -0.013, -0.006, p < 0.001), with helplessness driving the strongest effect (β = –0.023, 95%CI –0.03 to –0.02, p < 0.001). After adjusting for current pain level, sex, and the presence of active depression, PCS remained independently associated with QoL (b= -0.004, 95%CI -0.01, -0.004, p =0.03), greater pain interference (β = 0.230, 95%CI 0.090–0.370, p=0.002), and reduced participation in social roles (β = –0.338, 95%CI –0.52 to –0.156, p < 0.001). No association was found with physical function (b= -0.91, 95%CI -0.256, -0.074, p =0.276).

Conclusion: Our findings highlight the critical role of psychological pain processing in PsA. Pain catastrophizing—often undetected by standard clinical assessments—exerts a substantial and independent effect on patient-reported outcomes, even after accounting for actual pain intensity and depression. Addressing this process through interventions such as cognitive behavioral therapy or integrative psychosocial support may be necessary to improve holistic disease management and help patients achieve true remission and restoration of function.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/beyond-pain-severity-in-psoriatic-arthritis-pain-catastrophizing-independently-impacts-disease-burden-and-quality-of-life/