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An Overview of Juvenile Psoriatic Arthritis

written by: AngelicaMD • edited by: lrohner • updated: 2/25/2011

Chronic joint inflammation in children below 17 years old affects more than 300,000 children in the U.S. Some may also have skin manifestations that occur a few years later. Learn more about juvenile psoriatic arthritis, its diagnosis and treatment.

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    What is Juvenile Psoriatic Arthritis?

    Juvenile Psoriatic Arthritis (JPsA) is a condition where children, usually younger than 17 years old suffer from chronic joint pains and inflammation and skin rashes that look dry, scaly and silvery. JPsA is a subtype to juvenile arthritis which is an autoimmune disease, and with no known or identifiable cause.

    Joint pains and inflammation are symptoms of arthritis, and in this condition, a minimum of six weeks with these symptoms in children raises the possibility of juvenile arthritis. Any joint may be affected. Psoriasis is a skin condition that may also affect the nails and the scalp; these changes may occur with the arthritis or may appear before or after the joint pains are experienced. If rashes are not observed, a strong family history of psoriasis may be present in those with JPsA.

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    Symptoms of Juvenile Psoriatic Arthritis

    Some children may not manifest any symptoms at all. For those who do, they usually include:

    • Joint swelling, pain and tenderness that lasts for more than 6 weeks
    • Morning stiffness of the joints
    • Limping or inability to do previously learned motor skills
    • Persistent fever
    • Fatigue, weight loss, irritability
    • Eye pain, redness or blurring of vision
    • Dry, scaly, silvery rashes
    • Pitted fingernails
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    Diagnosis of JPsA

    It may be difficult to diagnose JPsA especially when the child is not symptomatic. Symptoms, if present, may also mimic other diseases like fibromyalgia, lupus, cancer, other bone and joint diseases and systemic infections.

    Aside from medical history and physical education, aids to diagnosis include:

    • Test for rheumatoid factor, to demonstrate presence of antibody found in arthritis
    • Test for autoimmunity - antinuclear antibody test
    • X-ray, MRI and bone scans to show inflammatory changes in the joints
    • Erythrocyte sedimentation rate – results are high in the presence of inflammation
    • Other blood and urine tests to exclude other possible causes of disease

    There are also other subtypes of juvenile arthritis which may be diagnosed using additional tests. Psoriasis may not be present at the time of consultation, and only a strong family history of this condition may give a clue to the diagnosis of JPsA.

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    Treatment of Juvenile Psoriatic Arthritis

    Early diagnosis and treatment of children with JPsA will help in preventing joint damage and deformity. The goals of treatment are to prevent disability and allow children to do normal activities in the home and school. To achieve these a team of specialist may be need to be involved with treatment, including the pediatrician, a rheumatologist, a radiologist, a physical therapist, and if needed, an ophthalmologist, an orthopedic surgeon and a nutritionist.

    Medications that help reduce pain and inflammation are given early and these consist of non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs and corticosteroids.

    Exercise is also important to these patients, and the help of a physical therapist may be needed. The goals of doing exercises are to reduce pain, improve joint mobility and strengthen the muscles. These will also help prevent joint deformity and disability while enabling the child to return to full physical functioning. Other modes of physical therapy may also be recommended such as the use of knee braces and the application of hot and cold treatments to relieve pain.

    In children who have acquired joint deformities surgery may be needed to alleviate the pain and correct the condition.

    A healthy diet that excludes high calorie foods and junk foods rich in sugar and salt is recommended. This strategy will prevent obesity that can add stress to the weight bearing joints.

    Skin rashes may be treated with topical medications to reduce inflammation, scaling and dryness. Oral medications may be used if the symptoms are not relieved by ointment and creams.

    Many children who are treated appropriately continue to live normal, healthy lives after the diagnosis of JPsA. With the help of parents, school and medical personnel children can enjoy full physical functioning.

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    References

    NYU Medical Center, “Juvenile Idiopathic Arthritis” accessed 2/17/11

    http://www.med.nyu.edu/hjd/centerforchildren/patient/jia.html

    WebMD, “Diagnosing Juvenile Arthritis” accessed 2/17/11

    http://www.webmd.com/rheumatoid-arthritis/diagnosing-juvenile-arthritis

    Mayo Clinic, “Psoriasis Treatment and Drugs” accessed 2/17/11

    http://www.mayoclinic.com/health/psoriasis/DS00193/DSECTION=treatments-and-drugs