Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Psoriatic juvenile idiopathic arthritis: Management and prognosis

Peter A Nigrovic, MD
Section Editor
Robert Sundel, MD
Deputy Editor
Elizabeth TePas, MD, MS


Psoriatic juvenile idiopathic arthritis (psJIA), or alternately juvenile psoriatic arthritis (JPsA), is a condition that can range widely in presentation and severity. Frank cutaneous psoriasis is not always evident, and the extent of articular involvement may vary from mild enthesitis (inflammation of sites at which ligaments, tendons, and other fibrous structures insert into bone) to polyarticular involvement of multiple axial (spine, sacroiliac joints) and peripheral joints.

The treatment and prognosis of psJIA are discussed here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of psJIA are discussed separately, as is psoriatic arthritis in adults. (See "Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis" and "Clinical manifestations and diagnosis of psoriatic arthritis" and "Treatment of psoriatic arthritis" and "Pathogenesis of psoriatic arthritis".)


Laboratory tests and imaging studies are of limited value in the management of psJIA. As in other subtypes of JIA, destructive arthritis may continue in the face of normal laboratory studies. Similarly, as with JIA generally, the role of conventional radiography in the day-to-day management of arthritis also is small since bony changes take months or years to become evident. Treatment should not be withheld because radiologic changes are not yet evident. Rather, careful clinical monitoring of the physical exam remains of paramount importance in following children with psoriatic arthritis. Monitoring for uveitis is discussed separately. (See "Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis", section on 'Laboratory findings' and "Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis", section on 'Radiologic studies' and "Oligoarticular juvenile idiopathic arthritis", section on 'Uveitis'.)


Treatment recommendations for psJIA are derived from trials in other JIA subtypes and from adult psoriatic arthritis since no randomized controlled trials (RCTs) have been conducted specifically in psJIA [1-5]. Management should be conducted in consultation with a pediatric rheumatologist and pediatric ophthalmologist whenever possible.

Peripheral arthritis — The treatment priority in psJIA, as in other types of JIA, is to extinguish synovitis in order to avoid damage to cartilage and bone. This imperative is particularly critical for the growing skeleton, where injury to growth plates and growth centers can cause permanent derangement of bone shape and length [6,7]. Absence of pain and lack of functional impairment are imperfect guides to successful therapy since children may adapt remarkably well to ongoing arthritis [8]. Such children may still go on to experience substantial joint injury, developing functional impairment later in childhood or as young adults [9].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Ruperto N, Lovell DJ, Cuttica R, et al. A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum 2007; 56:3096.
  2. Ruperto N, Lovell DJ, Quartier P, et al. Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial. Lancet 2008; 372:383.
  3. Lovell DJ, Ruperto N, Goodman S, et al. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med 2008; 359:810.
  4. Hashkes PJ, Laxer RM. Medical treatment of juvenile idiopathic arthritis. JAMA 2005; 294:1671.
  5. Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 2011; 63:465.
  6. Simon S, Whiffen J, Shapiro F. Leg-length discrepancies in monoarticular and pauciarticular juvenile rheumatoid arthritis. J Bone Joint Surg Am 1981; 63:209.
  7. ANSELL BM, BYWATERS EG. Growth in Still's disease. Ann Rheum Dis 1956; 15:295.
  8. McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics 2002; 110:354.
  9. Nigrovic PA, White PH. Care of the adult with juvenile rheumatoid arthritis. Arthritis Rheum 2006; 55:208.
  10. Beukelman T, Ringold S, Davis TE, et al. Disease-modifying antirheumatic drug use in the treatment of juvenile idiopathic arthritis: a cross-sectional analysis of the CARRA Registry. J Rheumatol 2012; 39:1867.
  11. Beukelman T, Guevara JP, Albert DA. Optimal treatment of knee monarthritis in juvenile idiopathic arthritis: a decision analysis. Arthritis Rheum 2008; 59:1580.
  12. Soriano ER, McHugh NJ. Therapies for peripheral joint disease in psoriatic arthritis. A systematic review. J Rheumatol 2006; 33:1422.
  13. Mease P, Genovese MC, Gladstein G, et al. Abatacept in the treatment of patients with psoriatic arthritis: results of a six-month, multicenter, randomized, double-blind, placebo-controlled, phase II trial. Arthritis Rheum 2011; 63:939.
  14. Hinks A, Bowes J, Cobb J, et al. Fine-mapping the MHC locus in juvenile idiopathic arthritis (JIA) reveals genetic heterogeneity corresponding to distinct adult inflammatory arthritic diseases. Ann Rheum Dis 2017; 76:765.
  15. Zisman D, Gladman DD, Stoll ML, et al. The Juvenile Psoriatic Arthritis Cohort in the CARRA Registry: Clinical Characteristics, Classification, and Outcomes. J Rheumatol 2017; 44:342.
  16. Nash P. Therapies for axial disease in psoriatic arthritis. A systematic review. J Rheumatol 2006; 33:1431.
  17. Gladman DD, Blake R, Brubacher B, Farewell VT. Chloroquine therapy in psoriatic arthritis. J Rheumatol 1992; 19:1724.
  18. Weiss PF, Xiao R, Biko DM, et al. Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary? Arthritis Rheumatol 2015; 67:2250.
  19. Wanders A, Heijde Dv, Landewé R, et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum 2005; 52:1756.
  20. Sieper J, Listing J, Poddubnyy D, et al. Effect of continuous versus on-demand treatment of ankylosing spondylitis with diclofenac over 2 years on radiographic progression of the spine: results from a randomised multicentre trial (ENRADAS). Ann Rheum Dis 2016; 75:1438.
  21. Sieper J, Appel H, Braun J, Rudwaleit M. Critical appraisal of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes. Arthritis Rheum 2008; 58:649.
  22. van der Heijde D, Landewé R, Baraliakos X, et al. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum 2008; 58:3063.
  23. Haibel H, Rudwaleit M, Listing J, et al. Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis: results of a twelve-week randomized, double-blind, placebo-controlled trial followed by an open-label extension up to week fifty-two. Arthritis Rheum 2008; 58:1981.
  24. Haroon N, Inman RD, Learch TJ, et al. The impact of tumor necrosis factor α inhibitors on radiographic progression in ankylosing spondylitis. Arthritis Rheum 2013; 65:2645.
  25. Jadon DR, Shaddick G, Jobling A, et al. Clinical outcomes and progression to orthopedic surgery in juvenile- versus adult-onset ankylosing spondylitis. Arthritis Care Res (Hoboken) 2015; 67:651.
  26. Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol 2001; 18:188.
  27. Stoll ML, Zurakowski D, Nigrovic LE, et al. Patients with juvenile psoriatic arthritis comprise two distinct populations. Arthritis Rheum 2006; 54:3564.
  28. Ekelund M, Aalto K, Fasth A, et al. Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year follow-up study. Pediatr Rheumatol Online J 2017; 15:13.
  29. Roberton DM, Cabral DA, Malleson PN, Petty RE. Juvenile psoriatic arthritis: followup and evaluation of diagnostic criteria. J Rheumatol 1996; 23:166.
  30. Flatø B, Lien G, Smerdel-Ramoya A, Vinje O. Juvenile psoriatic arthritis: longterm outcome and differentiation from other subtypes of juvenile idiopathic arthritis. J Rheumatol 2009; 36:642.
  31. Guzman J, Oen K, Tucker LB, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 74:1854.