Psoriatic juvenile idiopathic arthritis: Management and prognosis
- Peter A Nigrovic, MD
Peter A Nigrovic, MD
- Associate Professor of Medicine
- Harvard Medical School
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 . Such children may still go on to experience substantial joint injury, developing functional impairment later in childhood or as young adults .
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