Background Juvenile Psoriatic Arthritis (JPsoA) is a subtype of Juvenile Idiopathic Arthritis (JIA) present in 7% of JIA patients (1). Psoriasis is present in 0.5–1% of children. Diagnosis is often difficult, with the articular manifestations often preceding skin disease by years. Data is scarce in the Spanish population.
Objectives Describe demographical and clinical caracteristics of our cohort of JPsoA.
Methods Descriptive, transversal study of patients attended from 1/2012–12/2016. Included were all complyers with ILAR Criteria (2) for JPsoA (Edmonton 2001). We also included the Wallace Criteria for clinical inactive disease (3) as a variable and endpoint. Data were included and analyzed using SPSS MAC 20.
Results 31 patients were included: 18 (59%) girls, 13 (41%) boys. All Caucasian. They comprised 5% of all our JIA patients in that period.
Mean age at diagnosis was 7.4 years. All were RF-; 9 (29%) ANA+; 4 (12.9%) HLA-B27+; articular onset 17 (55%) and cutaneous onset 14 (45%). 9 (29%) had Temporomandibular Joint (TMJ) symptoms: 5 (16%) had pain and 4 (12.9%) had a positive MRI for TMJ synovitis.
Plaque psoriasis 14 (45%), guttata 3 (9.6%) and 3 (9.6%) had both. Dactylitis 8 (26.6%); enthesitis 6 (19.35%). Joint disease was mainly oligoarticular 15 (48%), monoarticular 14 (45%) and polyarticular 1 (3.2%). Axial disease 4 (12.9%) at follow-up. 7 (22.5%) uveitis; 5 (77%) were ANA +. 3 (9.6%) onicodistrophia and 6 (19.3%) enthesitis.
All patients received NSAIDs; 30 (96%) methotrexate; 6 (19.3%) switched to leflunomide. 16 (51.6%) received biologic treatment and 9 (29%) more than one. Articular debutants 10 (32.2%) received biologic treatment more than the those with cutaneous onset 6 (19.35%). We report 3 (9.6%) anti-TNF/paradoxal psoriasis events.
Wallace Inactivity Criteria were achieved in 25 (80.6%), with no differences between the biologic and DMARDS groups in time up to Achieving Wallace Criteria (TimeWall). TMJ positive MRI did have a negative effect on TimeWall with 2 (66.6%) ≥8 yr (8, 11y) to TimeWall.
Conclusions We describe the clinical features and demographics of a series of spanish JPsoA patients. We found more oligoarticular and monoarticular involvement and an important presence of enthesitis and dactylitis; higher frecuency of uveitis than published data (22.5% vs. 10–15%). Some were ANA-, reinforcing the need for screening. More than half required biologic treatment, and several cases we needed to switch drugs. Almost 60% of the patients were girls. Articular onset was associated with more active, harder to treat disease. TMJ positive RMI was associated with longer TimeWall. However, Wallace Criteria were not achieved globally.
T.R.Southwood, R.E. Petty, P.N. Malleson, et al. Psoriatic arthritis in children, Arthritis Rheum. 32 (1989) 1007–1013.
Petty RE, Southwood TR, Manners P, et al. ILAR Classification of Juvenile Idiopathic Arthritis: second revision, Edmonton 2001, J. Rheumatol. 31 (2004) 390–392.
Wallace CA, Giannini GH, Et Al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011 Jul;63(7):929–36.
Disclosure of Interest None declared