Sleep

Central sensitization in rheumatoid arthritis and psoriatic arthritis is associated with symptom burden than inflammatory activity: a cross-sectional study.

Dilek G, Unan M, et al. • Rheumatology international • 2026

PubMed 42189297 DOI 10.1007/s00296-026-06147-8

TL;DR

Central sensitization was present in 48.6% of patients with inflammatory arthritis and was independently associated with poorer sleep quality and fibromyalgia rather than disease diagnosis, inflammatory markers, or treatment modality.

Key Findings

Results

Central sensitization was highly prevalent in this cohort of inflammatory arthritis patients, affecting nearly half of all participants.

CS (defined as CSI ≥40) was present in 48.6% of the total cohort
The study included 93 patients with PsA and 92 patients with RA
CS was assessed using the Central Sensitization Inventory (CSI)
Data were collected in a rheumatology outpatient clinic between May 2025 and January 2026

Results

CSI scores were significantly higher in patients with psoriatic arthritis compared to those with rheumatoid arthritis.

CSI scores were reported as significantly higher in PsA patients (p<0.001)
Despite higher CSI scores in PsA, disease diagnosis (RA vs PsA) was not independently associated with CSI scores in multivariable regression analysis
This suggests that CS may develop independently of arthritis phenotype but imposes a greater clinical burden in PsA

Results

Patients with central sensitization demonstrated significantly greater disease burden across multiple clinical measures.

Patients with CS had higher tender joint counts, disease activity (DAS28), pain intensity, and patient- and physician-reported global assessments (all p<0.001)
Impaired sleep quality and neuropathic pain-like symptoms were significantly more pronounced in the CS group
Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and neuropathic pain-like symptoms with the painDETECT questionnaire (PDQ)

Results

CSI scores showed strong correlations with pain intensity, disease activity, tender joint counts, and poor sleep quality.

Strong correlations were observed between CSI scores and pain intensity
CSI scores also correlated strongly with DAS28 disease activity scores
Tender joint counts and poor sleep quality were among the key correlates of CSI scores
These associations were identified in cross-sectional correlation analyses prior to multivariable modeling

Results

In multivariable regression analysis, poorer sleep quality was independently and significantly associated with higher CSI scores.

Poorer sleep quality remained significantly associated with higher CSI scores (B=1.94, 95% CI 1.32–2.55; p<0.001)
This association was independent of other variables included in the model
Multivariable linear regression analyses were used to examine independent correlates of CSI scores

Results

Fibromyalgia was independently associated with higher CSI scores, while inflammatory markers and treatment modality were not.

Fibromyalgia was independently associated with higher CSI scores (B=11.79; 95% CI 5.57–18.02; p<0.001)
Disease diagnosis (RA vs PsA), inflammatory markers, and treatment modality were not independently associated with CSI scores
These findings suggest that CS-related symptom burden is driven more by non-inflammatory factors than by disease type or treatment

What This Means

This research suggests that central sensitization — a condition where the nervous system becomes overly sensitive to pain signals — is extremely common among people with inflammatory arthritis, affecting nearly half of those studied. Central sensitization was found in both rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and while PsA patients had somewhat higher scores on the central sensitization measurement scale, the type of arthritis diagnosis did not independently predict central sensitization levels when other factors were accounted for. This implies that the nervous system changes underlying central sensitization may occur regardless of which type of inflammatory arthritis a person has. Importantly, this research suggests that central sensitization is more closely tied to symptom burden — particularly poor sleep quality and the presence of fibromyalgia — than to markers of inflammation in the joints or the type of treatment a patient is receiving. Poor sleep quality and fibromyalgia were the two factors that independently predicted higher central sensitization scores, while inflammatory blood markers and medications did not. Patients with central sensitization also reported more pain, worse sleep, more neuropathic (nerve-related) pain symptoms, and higher overall disease burden. This research suggests that treating inflammation alone may not be sufficient to address the full pain experience of many arthritis patients. Clinicians may benefit from evaluating pain mechanisms, sleep quality, and overlapping conditions like fibromyalgia alongside standard inflammatory disease assessments. Early identification of central sensitization could support more comprehensive and personalized management strategies for people living with inflammatory arthritis.

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Citation

Dilek G, Unan M, Gokcen N, Uzun E, Ince G, Kamanli A, et al.. (2026). Central sensitization in rheumatoid arthritis and psoriatic arthritis is associated with symptom burden than inflammatory activity: a cross-sectional study.. Rheumatology international. https://doi.org/10.1007/s00296-026-06147-8

Key Findings

What This Means

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