Evaluation of alexithymia in patients affected by rheumatoid arthritis and psoriatic arthritis

Abstract

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic autoimmune diseases leading to joint damage, functional limitation, and disability and are typically associated with several comorbidities. Alexithymia is a personality trait characterized by a disregulation of emotion processing and regulation of emotions that involves a dissociation of emotional and physical responses to life events. A broad association between alexithymia and symptoms as depression, inflammation, and pain has been demonstrated. We aimed at evaluate an association among inflammatory arthritis, as RA and PsA, and alexithymia, and a possible link with clinical characteristics and disease activity.In this cross-sectional study, we enrolled, from January to December 2017, patients affected by RA or PsA referring to the outpatient's clinic of the Rheumatology Unit of the University of Rome Tor Vergata. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Disease activity, function, quality of life, and clinimetric indexes were assessed.A total of 50 RA patients and 51 PsA patients were enrolled. The TAS-20 score showed 38.6% (39/101) patients had alexithymia, 26.7% (27/101) patients were in the borderline of alexithymia and 34.7% (35/101) patients did not have alexithymia. A statistical significant association was observed between alexithymia and inflammatory indices (ESR: P = .029, CRP: P = .043) and between alexithymia and clinimetric parameters (ptVAS, pVAS, GH, P < .0001 for all comparisons). A significant trend of association has been demonstrated between alexithymia and female gender and concomitant steroid therapy. No correlations among variables such as age, duration of disease, and comorbidities and alexithymia status were observed.This study suggests that alexithymia assessment should be a part of the comprehensive management of RA and PsA patients.

<p>Alexithymia in Patients with Psoriasis: A Cross-Sectional Study from Ecuador</p>

“…Alexithymia is a personality trait considered as a risk factor for a variety of medical conditions, that may increase susceptibility to disease development 20. Previous publications assessing this personality trait in patients with rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis have estimated the prevalence at roughly one-third 21,22. In the case of patients with rheumatoid and psoriatic arthritis, alexithymia has been associated to higher levels of inflammatory indices such as erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), but does not appear to be correlated with demographic variables 21.…”

“…Previous publications assessing this personality trait in patients with rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis have estimated the prevalence at roughly one-third 21,22. In the case of patients with rheumatoid and psoriatic arthritis, alexithymia has been associated to higher levels of inflammatory indices such as erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), but does not appear to be correlated with demographic variables 21. On the other hand, in patients with plaque psoriasis, a significant relationship was found between the female gender and the sensitive area of involvement 22…”

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

“…20 These disorders have a great impact on QoL patients, lowering their pain threshold and reducing adherence to therapies. 33,34 Little evidence has been reported on any pulmonary diseases, but evidence supports that PsA patients present a tendency to develop drug-related lung fibrosis, especially in those treated with methotrexate (MTX) or TNFi. 35,36 As deducible, PsA represents a significant health issue having a profound impact on QoL: chronic pain together with the effects on bones and cartilages led to a limitation in physical functioning and work abilities, extreme fatigue, and emotional and social impairment.…”

Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation

“…In a more recent study, Chimenti et al assessed the prevalence of alexithymia in 50 patients with RA and 51 with PsA using the Toronto Alexithymia Scale (TAS-20), a self-reported questionnaire. Alexithymia was noted in 33.3% of patients with PsA [78]. Other tools used to determine alexithymia include the Bermond-Vorst Alexithymia Questionnaire (BVAQ), the Toronto Structured Interview for Alexithymia (TSIA) and the modified Beth Israel Hospital Questionnaire (BIHQ) [79].…”