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AB0997 Children with Psoriasis and Arthritis – an Important Clinical and Prognostic Issue That Challenges the Ilar-Classification
  1. M. Ekelund1,
  2. K. Aalto2,
  3. A. Fasth3,
  4. T. Herlin4,
  5. S. Nielsen5,
  6. E. Nordal6,
  7. S. Peltoniemi7,
  8. M. Rygg8,
  9. M. Zak5,
  10. L. Berntson9
  11. on behalf of Nordic Study Group of Pediatric Rheumatology (NoSPeR)
  1. 1Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
  2. 2Department of Pediatrics, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
  3. 3Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Pediatrics, Århus University Hospital, Århus
  5. 5Pediatric Rheumatology Department, Pediatric Clinic II, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  6. 6Department of Pediatrics, University Hospital of North Norway, Department of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway
  7. 7Pediatric Rheumatology Department, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
  8. 8Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology and Department of Pediatrics, St. Olav's Hospital, Trondheim, Norway
  9. 9Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden

Abstract

Background Among pediatric rheumatologists there is an on-going discussion whether juvenile psoriatic arthritis is an entity of its own or not. It is recognized that psoriatic arthritis is a disease with both autoimmune and autoinflammatory features. The ILAR-classification of psoriatic arthritis is under debate.

Objectives To study clinical signs, classification, and outcome in children with juvenile idiopathic arthritis (JIA) and psoriasis/psoriasis-like rash in a population-based cohort during the first eight years of disease.

Methods In total 440 children with JIA were included prospectively in a population-based cohort study. The presence of psoriasis and psoriasis-like rash during an eight years follow-up period was assessed in relation to clinical characteristics, ILAR-classification and remission.

Results - Of the 440 children 14 developed psoriasis and 13 psoriasis-like rash during the first eight years of disease.

  • 8/14 children with psoriasis and JIA were classified as juvenile psoriatic arthritis (JPA).

  • 6/14 children with psoriasis and JIA were classified as undifferentiated JIA. One was RF positive and the other five had concurrent signs of enthesitis-related arthritis.

  • Children with dactylitis and/or nail-pitting were spread among many ILAR categories.

  • Children with JIA and psoriasis/psoriasis-like rash had significantly higher number of cumulative active joints during the first eight years from disease onset than children with no psoriasis/psoriasis-like rash (p=0.02).

  • Dactylitis, nail pitting and enthesitis were significantly more common (0.01, <0.001, 0.03) in children with psoriasis/psoriasis-like rash compared to the rest of the cohort.

  • Children with and without psoriasis/psoriasis-like rash had the same outcome with regards to remission status after eight years.

Conclusions ILAR-criteria exclude children with spondylitis and enthesitis-related features from the JPA category. We suggest that this is not clinically relevant. Our results indicate a more severe disease course in children with psoriasis/psoriatisis-like rash and JIA, but the number of children with psoriasis/psoriasis-like rash was limited. There is a need to study children with psoriasis and arthritis in more detail regarding clinical pattern and prognosis.

Disclosure of Interest None declared

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