Teodora Serban ¹ Giuseppina Tramontano ¹ Monica Pendolino ¹ Dario Roccatello ² Oscar Massimiliano Epis ³ Florienzo Iannone ⁴ Ilenia De Andres ⁵ Marta Favero ⁶ Nicoletta Romeo ⁷ Guido Rovera ⁸ Leonardo Santo ⁹ Enrico Tirri ¹⁰ Alberto Bergamini ¹¹ Rosario Foti ¹² Carlotta Schenone ¹ Gerolamo Bianchi ^1*

• ¹ S.C. Reumatologia, ASL3 Genovese, Genova, Italy
• ² University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases, San Giovanni Bosco Hospital, Turin, Piedmont, Italy
• ³ Department of Rheumatology, Niguarda Ca 'Granda Hospital, Milano, Lombardy, Italy
• ⁴ Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
• ⁵ Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione "Garibaldi", Catania, Italy
• ⁶ Rheumatology Unit, Department of Medicine, University of Padova,, Padova, Italy
• ⁷ Azienda Ospedaliera S Croce e Carle,, Cuneo, Italy
• ⁸ Nuclear Medicine Unit, Department of Medical Sciences, School of Medicine, University of Turin, Turin, Piedmont, Italy
• ⁹ Rheumatology Unit, "Mons. Dimiccoli" Hospital, Barletta, Italy
• ¹⁰ UOSD di Reumatologia, Ospedale San Giovanni Bosco, Napoli, Italy
• ¹¹ Rheumatology, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
• ¹² Division of Rheumatology, A.O.U. "Policlinico-San Marco", Catania, Italy

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cutaneous psoriasis (PsO), first defined by Moll and Wright. Initially perceived as relatively benign, PsA is now recognized for its chronic, progressive, and destructive nature, significantly impacting patients' quality of life, similar to Rheumatoid Arthritis (RA). Globally, PsA represents about 20% of cases in early arthritis clinics, posing diagnostic and management challenges. Early diagnosis is crucial to prevent long-term disability and prevent comorbidities. While classification criteria for PsA are widely accepted, the lack of specific diagnostic criteria may delay diagnosis, with many patients experiencing delays of over a year before receiving an accurate diagnosis. For this reason, the exact prevalence of PsA remains uncertain. The MAnagement of PSoriatic Arthritis in Italy (MAPSI) project is a multicenter observational study aimed to investigate the prevalence of PsA and characteristics in an Italian cohort. This study included 454 patients diagnosed or confirmed by a rheumatologist across 25 Rheumatology Units in Italy. Data were collected on demographics, clinical features, and treatment histories. In our cohort, distinct gender differences were observed in PsA phenotype and disease impact. Men had a higher prevalence of axial involvement and were more likely to be current or former smokers, while women showed greater rates of enthesitis and reported higher perceived disease activity. Additionally, women had a higher prevalence of psychological comorbidities, whereas men had more severe skin involvement; laboratory tests were often unhelpful in diagnosing PsA, with elevated inflammatory markers in only about half of the cases. These findings highlight the need for gender-sensitive approaches in the management of PsA. Our findings highlight the importance of comprehensive patient evaluation, including extra-muscoloskeletal manifestation with a gender-sensitive approaches, focusing on a prompt diagnosis to prevent systemic comorbidities. Real-world data, such as those provided by the MAPSI study, are essential for understanding the burden of PsA and developing effective management strategies tailored to patient characteristics.