Psoriatic arthritis is an inflammatory arthritis affecting the joints and connective tissue and is associated with psoriasis of the skin or nails. People with psoriatic arthritis presenting with oligoarticular disease progress to polyarticular disease and a large percentage develop joint lesions and deformities, which progress over time. Juvenile onset. This accounts for up to a fifth of childhood arthritis and usually starts as a monoarthritis, but DIP pattern may be seen. DIP joint involvement), the swelling of an entire digit (dactylitis), the presence of enthesitis, and the absence of RF (or anti-citrullinated antibodies). Psoriatic arthritis is a chronic inflammatory arthritis that develops in at least 5 of patients with psoriasis. See Psoriasis: Manifestations, Management Options, and Mimics, a Critical Images slideshow, to help recognize the major psoriasis subtypes and distinguish them from other skin lesions. Psoriatic nail changes, which may be a solitary finding in patients with psoriatic arthritis, may include the following:. A family history of psoriasis (in the absence of current psoriasis and history of psoriasis; assigned a score of 1). Juvenile psoriatic arthritis. We evaluated the role of enthesitis in dactylitis associated with psoriatic juvenile idiopathic arthritis (psJIA) in a child who underwent detailed imaging and histologic evaluation. This may be in part due to the extreme rarity of enthesis biopsies and in part due to the lack of familiarity of pathologists with this lesion.
Stratification of psoriatic disease according to the sex of the patients, genetic factors or age at onset has allowed in the last few years a better understanding of the principles governing the onset and progression of these processes. It is also known that PsA tends to appear earlier in patients with HLA-B 27 positivity, and that these patients also show a shorter interval of time between the onset of cutaneous lesions and the onset of joint disease. Younger patients with juvenile PsA usually require more intensive therapy with MTX to achieve remission. There were no gender differences in age at onset of psoriasis or arthritis, family history of disease, DIP involvement, dactylitis, nail disease, the presence of erosive disease in the radiological study or severity of psoriasis 65. Psoriasis is a common chronic inflammatory cutaneous disease affecting 0.5 to 2 of children and adolescence (1). However, Guttate and flexural forms are particularly common in children and characterized by pruritic plaque lesions that are thinner, softener and less scaly than those seen in adults with most involvement of face and flexural area (5, 12). Due to lack of approved therapies and standardized methodology, this paper provided a review on the management of psoriasis in children. Psoriatic arthritis should be differentiated with juvenile rheumatoid arthritis and ankylosing spondylitis (18). Arthritis is associated with psoriasis or two of the following:(1) dactylitis,(2) nail pitting,(3) onycholysis,(4) psoriasis in a first degree relative. After 2 years of clinical remission on this therapy, psoriasiform lesions appeared on elbows and knees, and a diagnosis of psoriasis was made. Clinical remission was rapidly obtained, with absence of joint swelling and uveitis flares.
Age At Disease Onset: A Key Factor For Understanding Psoriatic Disease