TOPLINE:

Psoriasis was associated with chronic pain, multiple pain sites, and higher pain intensity in a population-based study; the association with multiple pain sites persisted even after excluding patients with psoriatic arthritis (PsA), suggesting possible undiagnosed PsA or neuroimmune mechanisms.

METHODOLOGY:

• Researchers conducted a cross-sectional study using data of patients with psoriasis from three large population-based cohorts: the Rotterdam Study in Netherlands (n = 2965) in 2021-2024 and the Tromsø Study in Norway (Tromsø6 [n = 11,558] in 2007-2008 and Tromsø7 [n = 11,813] in 2015-2016).
• In the Rotterdam Study, psoriasis was defined as physician-diagnosed psoriasis, which was self-reported and validated using GP records, and in Tromsø, it was defined as self-reported ever-psoriasis or physician-diagnosed psoriasis.
• Pain outcomes included chronic pain (defined as pain lasting at least 3 months with one or more pain sites and pain intensity ≥ 2 on a numeric rating scale), the number of pain sites from cohort-specific body maps or region lists, and pain intensity assessed on the same numeric rating scale.
• Quantitative sensory testing measures included the cold pressor test (hand immersion in 3 °C water; maximum duration, 106-121 seconds) and cuff pressure algometry (calf cuff inflation at 1 kPa/sec to a maximum of 100 kPa or until intolerable pain).
• Associations between psoriasis and pain outcomes and quantitative sensory testing outcomes were assessed, with sensitivity analyses excluding participants with PsA.

TAKEAWAY:

• In the pooled meta-analyses, psoriasis was associated with chronic pain (odds ratio [OR], 1.28; 95% CI, 1.17-1.40), more pain sites (incidence rate ratio [IRR], 1.28; 95% CI, 1.13-1.46), and higher pain intensity (OR, 1.24; 95% CI, 1.12-1.38).
• In Tromsø7, active psoriasis showed stronger associations with chronic pain (OR, 1.46; 95% CI, 1.23-1.72), pain sites (IRR, 1.41; 95% CI, 1.30-1.52), pain intensity (OR, 1.29; 95% CI, 1.12-1.48), and reduced cold pain tolerance as measured using the cold pressor test (hazard ratio [HR], 1.11; 95% CI, 1.00-1.23). Similar associations were observed in Tromsø6.
• After excluding patients with PsA, the association with the number of pain sites persisted in both main analysis (IRR, 1.08; 95% CI, 1.02-1.15) and Tromsø7 (IRR, 1.17; 95% CI, 1.05-1.29), whereas associations with chronic pain and pain intensity attenuated.
• No significant associations were found with cuff pressure algometry in any analyses (HR, 1.00; 95% CI, 0.95-1.05 in the main analysis; HR, 0.99; 95% CI, 0.93-1.04 in Tromsø7).

IN PRACTICE:

"Overall, psoriasis was associated with adverse pain outcomes, largely explained by concomitant PsA, whereas the association with number of pain sites persisted after exclusion of known PsA," the authors wrote. "Longitudinal studies are needed to clarify temporality and whether the number of pain sites predicts incident PsA," they concluded.

SOURCE:

This study was led by Juliette Bollemeijer, Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands. It was published online on June 01, 2026, in Acta Dermato-Venereologica.

LIMITATIONS:

The study had a cross-sectional design; psoriasis was primarily self-reported, and cross-cohort assessments differed. Data on PsA, psoriasis activity, and severity were not available in all cohorts, which may have affected the ability to fully account for these factors across the entire study population. Included patients were predominantly middle-aged or older patients, which may have limited generalisability to other age groups.

DISCLOSURES:

The Rotterdam Study was funded by the Erasmus Medical Center and Erasmus University in Rotterdam; the Netherlands Organisation for Health Research and Development; the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission; and the Municipality of Rotterdam. The Tromsø Study was funded by the University of Tromsø - The Arctic University of Norway, the Northern Norway Regional Health Authority, the Norwegian Ministry of Health and Care Services, the University Hospital of North Norway, and Troms county, as well as various sources for subprojects. One author reported receiving support from Unilever. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.