Joint pain, itch drives fatigue in patients with psoriasis with or without PsA

Key takeaways:

• Increased joint pain and itch was significantly linked to an increase in overall fatigue.
• Disease severity was also associated to a lesser extent with fatigue.

Fatigue among patients with psoriasis with or without psoriatic arthritis was associated with joint paint, itch and, to a lesser extent, disease severity, according to a study.

“It is well established that people with psoriasis have a higher prevalence and risk of sleep-related conditions such as obstructive sleep apnea,” Lea Nymand, MSc, of the department of dermatology, Bispebjerg Hospital, University of Copenhagen, and colleagues wrote. “To date however, most research in psoriasis has focused on sleep disturbance rather than fatigue itself.”

According to the authors, many studies suggest that fatigue is more common among patients with psoriatic arthritis (PsA) compared with psoriasis alone, making the impact of psoriasis on fatigue poorly understood.

To explore the characteristics of fatigue and potential drivers of fatigue among patients with psoriasis with or without PsA, the authors conducted a cross-sectional study of 2,741 adults with psoriasis, 593 of whom also had PsA, and 3,788 controls.

Participants completed the Multidimensional Fatigue Inventory-20 (MFI-20), a 20-item questionnaire that measures general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue.

Results showed that while total fatigue was more highly associated with PsA (B = 5.23; 95% CI, 3.55-6.9) vs. psoriasis alone (B = 2.1; 95% CI, 0.96-3.25), a lack of sleep was not the only contributor to fatigue in patients with psoriasis.

Joint pain had a significant correlation to fatigue with every 1-point increase in joint pain on the numerical rating scale causing an increase in overall fatigue among patients with or without PsA (B = 2.23; 95% CI, 2.03 to 2.44).

Similarly, itch intensity was significantly associated with fatigue, with the total fatigue scores for both psoriasis and PsA patients increasing by 0.47 (95% CI, 0.18-0.77) for every 1-point increase in itch.

To a lesser extent, disease severity was also linked to fatigue among patients with moderate (B = 1.88; 95% CI, 0.15-3.69) and severe psoriasis (B = 2.21; 95%, CI, 0.52-3.91) compared with mild psoriasis.

“These findings highlight the importance of a symptom-based approach when treating psoriasis, rather than focusing on objective severity measures alone,” the authors concluded.