Background/Objectives: Many studies have addressed the sex differences in patients with psoriatic arthritis, although these are aimed more at describing the phenotype than at investigating the causes underlying these differences. The aims of our study were to assess the presence of clinical features in relation to sex, and to measure the effect on disease activity of different comorbidities in each sex. Methods: This was a cross-sectional study in which the following factors were measured: the clinical features of the disease, disease activity, the physical function and the disease impact. We measured serum leptin levels, to eliminate the effect of obesity on leptin levels, and a leptin/BMI ratio was calculated. The comorbid conditions evaluated included anxiety and depression, and sleep quality. Results: A total of 203 patients participated in this study. The mean age was 54.6 ± 11.3, and 46.8% of the patients were women. Women less frequently presented axial involvement (8% vs. 28%; p < 0.001) and more commonly had enthesitis (2 vs. 0.3; p < 0.001). They also had higher DAPSA (16.4 vs. 13.4; p < 0.001) and PsAID12 scores (4.1 vs. 2.9; p < 0.001), worse HAQ results (0.8 vs. 0.5; p < 0.001), and greater FACIT-F scores (32.7 vs. 38.1; p < 0.001). As for the comorbid conditions, women presented a higher leptin/BMI ratio (0.8 vs. 0.2; p < 0.001), higher levels of HADS-A (6.9 vs. 4.7; p < 0.001) and HADS-D (4.9 vs. 3.4; p < 0.001), and poorer ISI (9.3 vs. 7.0; p < 0.001). By sex, pain affecting women was associated with the leptin/BMI ratio (β: 0.29; p < 0.004; 95%CI: 0.3–1.6) and sleep quality (β: 0.31; p < 0.004; 95%CI: 0.04–0.25; R²: 0.26). The leptin/BMI ratio was not associated with pain in men (p = 0.46). Conclusions: Sex was associated with several clinical manifestations. Leptin/BMI ratio levels were associated with pain in women, but not in men.

Background: Central sensitization (CS) contributes to persistent pain in psoriatic arthritis (PsA), yet its prevalence, independent predictors, and association with therapeutic refractoriness remain incompletely characterized across disease phenotypes. Objectives: To evaluate CS prevalence and clinical correlates in unselected PsA patients excluding fibromyalgia, with emphasis on predictors, multidimensional pain phenotypes, and the association between CS and therapeutic refractoriness. Design: Cross-sectional observational study. Methods: A total of 228 consecutive PsA patients were recruited from April to November 2025 at a single tertiary center. Patients with fibromyalgia (2016 modified ACR criteria, systematically screened) were excluded. CS was assessed using the Central Sensitization Inventory (CSI ⩾40). Disease activity, functionality, pain phenotypes (PAIN DETECT questionnaire (PDQ)), sleep quality (Pittsburgh Sleep Quality Index), depression and anxiety (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) and therapeutic refractoriness were systematically measured. Binary and linear regression analyses identified independent predictors of CS. Results: CS was present in 35.1% of patients. CS was associated with higher disease activity indices (Clinical Disease Activity Index for Psoriatic Arthritis: 14 vs 9.8, p = 0.001; Ankylosing Spondylitis Disease Activity Score with C-reactive protein: 4.8 vs 1.8, p = 0.007), greater functional disability (Health Assessment Questionnaire—Disability Index: 0.8 vs 0.2, p = 0.001), increased neuropathic pain (55.6% vs 8.2%, p = 0.001), and notably higher prevalence of therapeutic refractoriness (61.5% vs 6.8%, p = 0.003). Independent predictors of CS presence were depression severity (HADS-D: odds ratio (OR) = 1.32, p = 0.01), poor sleep quality (Pittsburgh Sleep Quality Index: OR = 1.21, p = 0.001), and PDQ (OR = 1.07, p = 0.03). Depression, sleep quality, and fatigue explained 47% of CS variance in linear regression. Conclusion: Approximately one-third of unselected PsA patients experience CS, which independently contributes to therapeutic refractoriness despite inflammatory control. Psychosocial factors—particularly sleep dysfunction and depression—emerge as robust predictors of CS. These findings support systematic CS screening in PsA patients with inadequate symptomatic response and highlight the need for integrated biopsychosocial interventions addressing both inflammatory and non-inflammatory pain mechanisms.

Background: Obstructive sleep apnea (OSA) is increasingly recognized in chronic inflammatory diseases, yet its prevalence and clinical correlates in psoriatic arthritis (PsA) remain poorly characterized. Objective: The objective of this study was to evaluate OSA prevalence and its relationship with disease activity, functional impairment, and comorbidities in PsA patients. Methods: A cross-sectional analysis of 247 consecutive PsA patients was conducted. OSA diagnosis was determined through medical record review. Disease activity was assessed using cDAPSA and ASDAS-CRP. Functional disability was measured using HAQ-DI and BASFI. Sleep quality (PSQI) and psychological symptoms (HADS) were evaluated. Inflammatory markers included CRP, IL-6, and TNF-α. Multivariable logistic regression identified independent predictors of OSA. Results: OSA prevalence was found to be 8.9% (22/247). OSA+ patients had significantly higher median age (58.0 vs. 54.0 years, p = 0.02), tender joint count (2.0 vs. 1.0, p = 0.002), functional disability (1.1 vs. 0.3, p = 0.001), fatigue (30.5 vs. 38.0, p = 0.04), anxiety (7.5 vs. 5.0, p = 0.03), depression (7.0 vs. 3.0, p = 0.004), and worse sleep quality (11.5 vs. 7.0, p = 0.001). Notably, no significant differences in inflammatory markers (CRP, swollen joints) were found between groups despite substantially higher pain burden in OSA+ patients. Female sex and greater tender joint count emerged as independent predictors of OSA. Conclusions: OSA occurs in ~9% of unselected PsA patients and is independently associated with functional disability, psychological distress, and elevated tender joint counts despite comparable inflammatory markers. This dissociation suggests that OSA drives pain amplification through non-inflammatory mechanisms. These findings support the use of systematic OSA screening in PsA patients with pain or disability disproportionate to inflammatory burden, particularly in those with psychological comorbidities.

Introduction/Objectives: Restless legs syndrome (RLS), a chronic neurological disorder related to brain iron metabolism, has been linked to immune-mediated inflammatory conditions such as psoriatic arthritis (PsA). However, the role that inflammation plays in this association and the impact of RLS on PsA outcomes remain unclear. This study aims to investigate the association between RLS and inflammatory/clinical parameters in PsA patients. Materials and Methods: In this cross-sectional study, 230 PsA patients completed the International Restless Legs Syndrome Study Group (IRLSSG) screening questionnaire, with diagnoses confirmed by a neurologist. Data collected included clinical features, disease activity, and comorbidities (obesity, anxiety, depression, insomnia, and fibromyalgia). Results: In total, forty-six patients met the IRLSSG criteria (20%). Those with RLS more frequently had polyarthritis (27% vs. 6%; p < 0.001), more swollen joints (2.0 vs. 1.4; p = 0.04), greater psoriatic involvement (5.7 vs. 3.6; p < 0.001), greater fatigue (39.0 vs. 30.5; p < 0.001), and greater disease activity (14.5 vs. 10.5; p < 0.001). They also exhibited increased disease impact (4.7 vs. 2.9; p < 0.001), poorer functioning (0.7 vs. 0.5; p = 0.01), and higher levels of anxiety (8.0 vs. 5.5; p < 0.001), depression (6.5 vs. 3.9; p < 0.001), and sleep disturbance (13.9 vs. 8.7; p < 0.001). Skin lesions and polyarthritis explained nearly 40% of RLS cases (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.03–2.0; p = 0.03 and OR 1.03; 95% CI 1.00–1.9; p = 0.04). Conclusions: Psoriatic activity and inflammation may contribute to RLS in PsA. The coexistence of RLS was associated with greater disease activity, greater disease impact, and more emotional and sleep-related comorbidities.

Many studies have addressed sex differences in patients with psoriatic arthritis, although these are aimed more at describing the phenotype than at investigating the causes underlying the differences. Cross-sectional study of 203 patients. The clinical and demographic variables included age, years of education, time since onset, smoking, type of treatment, clinical presentation, number of entheses affected, dactylitis, fatigue, and cutaneous involvement. Disease activity,functioning and disease was measured. The comorbid conditions evaluated included obesity (and leptin as an associated parameter), anxiety and depression, and sleep quality. Mean age was 54.6, and 46.8% of patients were women. Women less frequently presented axial involvement and more frequently presented enthesitis. They also presented greater disease activity, greater disease impact, and poorer functioning, as well as greater fatigue. As for comorbid conditions, women presented a higher leptin/BMI ratio, higher levels of anxiety and depression, and poorer sleep quality. By sex, pain affecting women was associated with the leptin/BMI ratio and sleep quality. The leptin/BMI ratio was not associated with any component of disease activity in men. Sex was associated with several clinical manifestations, disease activity, functioning, and disease impact. Leptin was associated with intensity of pain in women.