Joint pain, morning stiffness, swollen fingers or toes, persistent tiredness. Symptoms often attributed to age, stress or small musculoskeletal problems which instead may be a sign of a chronic inflammatory disease.
Psoriatic arthritis is an autoimmune disease that affects joints, tendons and entheses, the structures that connect tendons and ligaments to bones. It can occur in people who suffer from psoriasis and appear even many years after the first skin lesions.
According to the main international scientific societies, it affects a share of the population estimated between 0.3% and 1%, although the data could be underestimated due to frequent diagnostic delays. Early diagnosis today represents one of the priority objectives of the scientific community. Numerous studies have in fact shown that timely control of inflammation can limit permanent joint damage, preserve functionality and improve long-term prognosis.
According to Professor Carlo Selmi, Professor of Internal Medicine at Humanitas University and Head of the Rheumatology and Clinical Immunology Operational Unit of the IRCCS Humanitas Clinical Institute of Rozzano: "psoriatic arthritis is a heterogeneous disease that can involve peripheral joints, the spine, tendons and ligaments and which precisely because of this complexity can be confused with other forms of musculoskeletal pain". The expert also underlines how the pathology presents different characteristics compared to rheumatoid arthritis, despite sharing some symptoms, and therefore requires a specific diagnostic path based on clinical evaluation, the patient's history and the integration of different skills.
Diagnosis still late: the burden of underestimated symptoms
One of the main problems remains the diagnostic delay. Many patients live for years with symptoms that are not correctly interpreted or linked to psoriasis. "Even today, many people reach the diagnosis five or seven years after the onset of symptoms. Often those who suffer from psoriasis and complain of joint pain are not immediately directed towards rheumatology", highlights Silvia Tonolo, President of the National Association of Rheumatic Patients - ANMAR Onlus.
The result is that the disease continues to progress as the inflammation progressively compromises joints and functional abilities.
For this reason, specialists insist on the need to promptly recognize some warning signs: persistent joint pain, stiffness in the morning that lasts more than thirty minutes, swelling of the fingers, pain in the heels or tendon insertions and chronic fatigue.
New therapies and the value of teamwork
In recent years, research has profoundly changed the therapeutic scenario of psoriatic arthritis. Today, biological drugs and innovative molecules are available that are capable of acting on specific inflammatory mechanisms, allowing increasingly effective control of the disease. "The goal is not only to reduce pain, but to control inflammatory activity, prevent joint damage and allow patients to maintain a fully active life" - explains Selmi.
The management of the pathology also requires a multidisciplinary approach involving rheumatologists, dermatologists, general practitioners and other specialists, especially in cases where there are manifestations affecting different organs and systems.
A particularly important aspect concerns the social impact of the disease. Psoriatic arthritis frequently affects people of working age, between 30 and 50 years old, with consequences that can impact professional activity, family life and social participation. "Today we have diagnostic and therapeutic tools that allow us to offer a good quality of life to patients. The sooner we reach the diagnosis, the lower the social and health costs linked to the disease will also be" - concludes Tonolo.
Mental health, a global challenge affecting 1.17 billion people
If for many chronic diseases the problem is recognizing the symptoms, in the case of mental health the challenge is even broader: overcoming stigma, prejudice and misinformation. The new data from the Global Burden of Disease 2023, published in The Lancet in 2026, describe a situation of great health importance. Around the world, approximately 1.17 billion people live with a mental disorder. Mental illnesses now represent the fifth global cause of health loss and the leading cause of years lived with disability.
From 1990 to 2023, cases increased by 95.5%, while the overall disease burden grew by more than 100%. Among the conditions that recorded the most significant increases were anxiety disorders (+64.9%) and major depression (+41.3%).
Mental health does not mean the absence of suffering
To understand the numbers, however, we need to start from a correct definition. The World Health Organization defines mental health as a state of well-being that allows people to realize their abilities, cope with the normal difficulties of life, work productively and contribute to the community.
According to Prof. Caterina A. Viganò, IAPP Psychiatrist and Psychotherapist, Associate Professor of Psychiatry at the Department of Biomedical and Clinical Sciences of the University of Milan and Head of the UOS Sacco Rehabilitation Centers of the ASST Fatebenefratelli Sacco, it is important to overcome a very widespread misunderstanding: "mental health does not coincide with happiness and not every moment of sadness, stress or suffering necessarily represents a disease". On the contrary, experts explain, mental health concerns the ability to adapt to life events, develop resilience and maintain meaningful relationships even in the most difficult phases.
Young people and adolescents: the greatest burden of the disease is concentrated here
One of the most significant elements that emerged from the study published in The Lancet concerns the age of onset. The peak burden of mental illness is recorded between the ages of 15 and 19, while the 20-24 age range represents a particularly delicate phase of transition towards adulthood. Furthermore, approximately half of mental disorders begin by age 14 and 75% by age 25.
"Intercepting signs of distress early means changing people's life trajectories before the suffering becomes chronic" - underlines Viganò, recalling the value of prevention and early intervention. Among the factors that contribute to the increase in mental disorders, scholars indicate the effects of the pandemic, social isolation, economic inequalities, global crises, traumatic experiences, bullying and the weakening of relational and community networks.
Mental health and brain health: an inseparable combination
Another of the central messages that has emerged from the most recent scientific literature concerns the link between mental health and brain health. Emotions, behaviors, memory, attention and relational abilities in fact arise from brain functioning and cannot be considered separate elements. For this reason, specialists increasingly insist on an integrated approach that brings together neurology, psychiatry, psychology, education and prevention, favoring a vision of mental health as an integral part of the person's general health.
Milano4MentalHealth: when mental health enters the life of the city
The response to the growing spread of psychological distress cannot be entrusted exclusively to health services. This is the philosophy that animates Milano4MentalHealth, the initiative promoted by the Municipality of Milan which every year dedicates the month of October to events, meetings, cultural activities, awareness campaigns and moments of discussion open to citizens on the topic of mental health.
As Lamberto Bertolé, Councilor for Welfare and Health of the Municipality of Milan and President of the WHO Italian Healthy Cities Network, highlights: "mental health is a collective responsibility that concerns institutions, the world of school, culture, volunteering and the whole community". The value of cities lies in the ability to build inclusive contexts, combat stigma and promote social relationships that represent fundamental protective factors for people's psychological well-being.
The objective of Milano4MentalHealth is precisely to take the topic out of the clinics and make it part of the daily lives of citizens, promoting a culture of prevention and listening. Because, as international data highlights, there is no health without mental health. And building communities capable of recognizing hardship, combating stigma and promoting access to care represents one of the main public health challenges today.
