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Study results showed that patients with psoriatic arthritis or axial spondyloarthritis had a greater prevalence of headache than control participants.

Patients with psoriatic arthritis, axial spondyloarthritis, or both carry a heavy burden of headache and migraine, according to new data published online in Biomedicines.

“Our study focuses on a single-center cohort of Italian rheumatology patients afflicted with rheumatological diseases such as psoriatic arthritis and ankylosing spondylitis, where headache is a prevalent comorbidity,” Annalisa Marino, MD, a rheumatologist and researcher at Università Campus Bio-Medico di Roma, Italy, says. “Currently, there is limited literature addressing this topic, particularly concerning the comorbidity of migraine and migraine with aura. The shared inflammatory background between spondyloarthritis and headache prompted our investigation into whether there exists a common pathogenesis and therapeutic approach for these patients.”

Dr. Marino and colleagues performed a cross-sectional study of 286 participants. This cohort included 87 healthy controls, 216 patients with psoriatic arthritis, and 70 patients with axial spondyloarthritis. All participants came from a single center in Italy. The research team required patients with psoriatic arthritis to fulfill the Classification Criteria for Psoriatic Arthritis and to have already undergone at least six months of treatment with biologics, conventional therapies, or both to participate. Patients with axial spondyloarthritis were required to be diagnosed via the New York criteria for ankylosing spondylitis or the Assessment of SpondyloArthritis International Society criteria. Exclusion criteria included a history of cancer, psychiatric disorders, pregnancy, and inability to provide informed consent. The researchers assessed the number of tender and swollen joints, as well as dactylitis and enthesitis, and assessed skin using the Psoriasis Area Severity Index (PASI) score. They also collected a variety of disease activity scores at baseline. The study team diagnosed participants with headache, migraine, or both by way of a semistructured diagnostic interview using the International Classification of Headache Disorders.

Patients with psoriatic arthritis or axial spondyloarthritis had a significantly greater prevalence of headache than healthy control participants, the researchers reported (Table). In those with psoriatic arthritis, the prevalence of headache was reported at 39.81% (n=86), whereas those with axial spondyloarthritis had a reported headache prevalence of 45.71% (n=32), compared with 26.44% of the control group (P=0.028 for psoriatic arthritis versus control; P<0.05 for axial spondyloarthritis versus control).

This increased prevalence held for migraine. Migraine without aura reportedly occurred in 18.52% of those who had psoriatic arthritis, compared with 28.57% of those with axial spondyloarthritis and 9.2% of the control group (P=0.044 for psoriatic arthritis versus controls; P<0.05 for axial spondyloarthritis versus controls). The prevalence of migraine with aura was similar across the three groups, the researchers reported.

“When considering both patient populations, headache prevalence was 41.26%, and migraine without aura was 20.98%, significantly higher than in controls (P=0.013),” Marino noted.

“Our findings reveal a higher prevalence of headache and migraine without aura in PsA and axial spondyloarthritis patients compared to healthy controls, suggesting a link between systemic inflammation in spondyloarthritis and the immunological and pain-related mechanisms underlying headache and migraine development,” Dr. Marino says. “This aligns with similar observations in autoimmune diseases characterized by chronic pain, such as multiple sclerosis. It is crucial for rheumatologists to incorporate this understanding into their practice, considering the prevalence of this comorbidity and exploring appropriate therapies through further research.”

“Future research should address the need for new studies investigating novel drugs and therapies targeting autoimmune diseases. Such interventions, by addressing the immuno-rheumatological aspect, may also address prevalent neurological and cardiovascular comorbidities associated with these conditions,” she concludes.