Juvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis?

Yonatan Butbul Aviel,Brian M Feldman,Rayfel Schneider,Pascal Tyrrell,Bonnie Cameron,Ronald Laxer,Lynn Spiegel,Earl Silverman,Sandeep Dhillon,Rotraud K Saurenmann,Shirley Ml Tse

doi:10.1186/1546-0096-11-11

Abstract

BackgroundFollowing the introduction of the ILAR criteria for juvenile idiopathic arthritis, juvenile psoriatic arthritis (JPsA) has become a better recognized category within the inflammatory arthritides of childhood. There are fewer reports describing the characteristics and long-term outcome of patients with JPsA than other subtypes of JIA.The aim of our study was to determine the long-term outcome and clinical course of patients with juvenile psoriatic arthritis (JPsA) and to define subgroups of JPsA.MethodsClinical records of all patients meeting criteria for JPsA were reviewed and divided into 4 groups depending on their clinical features and onset type. Patient characteristics and clinical features at onset and during follow-up were determined.ResultsThe cohort consisted of 119 patients: 65 with oligoarticular-onset (55%; persistent 44 and extended 21), 34 (29%) with RF(-) and 4 (3%) RF(+) polyarticular and 16 (13%) enthesitis-related arthritis (ERA). At diagnosis patients with ERA were oldest and more commonly male (p=0.001 and =0.01 respectively). Patients with a polyarticular course had more involvement of small joints of the hands and wrist when compared to patients with persistent oligoarticular and ERA (p<0.001) while patients with ERA had more hip and sacroiliac arthritis (p<0.001 for both). Nail changes were seen in 66 patients (57%) and were associated with DIP involvement (p=0.0034).Outcome: Time to first inactive disease on, but not off, therapy was significantly longer among patients with polyarticular course when compared to oligoarticular and ERA (p=0.016 and p=0.48 respectively). Patients with polyarticular course more frequently had contractures during follow-up than other groups (p=0.01).ConclusionThe long-term outcome of with JPsA was generally good. Patients with JPsA did not appear to form distinct sub-group of patients but rather resembled JIA patients with onset types without psoriasis.

Highlights

Following the introduction of the ILAR criteria for juvenile idiopathic arthritis, juvenile psoriatic arthritis (JPsA) has become a better recognized category within the inflammatory arthritides of childhood
The other 20 patients would have been excluded from the study if only ILAR criteria were used: a) 4 patients tested positive for rheumatoid factor on at least two occasions; and b) 16 patients met the criteria for enthesitis-related arthritis (ERA)
Thirty-three patients were diagnosed with psoriasis before the onset of arthritis, 30 patients at the same time and in 40 patients the diagnosis of psoriasis was made after the onset of arthritis

Summary

Introduction

Following the introduction of the ILAR criteria for juvenile idiopathic arthritis, juvenile psoriatic arthritis (JPsA) has become a better recognized category within the inflammatory arthritides of childhood. There are fewer reports describing the characteristics and long-term outcome of patients with JPsA than other subtypes of JIA. The aim of our study was to determine the long-term outcome and clinical course of patients with juvenile psoriatic arthritis (JPsA) and to define subgroups of JPsA. Patients defined as having JPsA, within the ILAR classification, must have a persistent arthritis of greater than 6 weeks with onset of the arthritis prior to age 16 and either the presence of a psoriatic rash, or in the absence of rash, at least 2 of the Criteria. As more than one classification system for JPsA has been used, it can be confusing to compare different studies and, as recently as 2008, no single classification was agreed upon or universally accepted [12].

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