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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