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Subgroups of juvenile psoriatic arthritis patients resembled JIA
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Patients with juvenile psoriatic arthritis experienced good long-term outcomes and did not appear to form a distinct patient subset, instead resembling juvenile idiopathic arthritis patients with onset types excluding psoriasis, according to study results.
Researchers in Toronto reviewed the clinical records of 119 patients (67% females) meeting the criteria for juvenile psoriatic arthritis (JpsA; mean age at presentation, 8 years), then divided them into four groups based on clinical features and onset type. The researchers also determined patient characteristics and clinical features at onset and during follow-up.
Sixty-five patients were oligoarticular-onset (persistent, 44; extended, 21), 34 were rheumatoid factor (RF) negative polyarticular, four were RF positive polyarticular, and 16 had enthesitis-related arthritis (ERA). Patients with ERA were oldest (P=.001), more commonly male (P=.01) at diagnosis and experienced more hip and sacroiliac arthritis (P<.001 for both). More involvement of small joints of the hands and wrists occurred in polyarticular patients compared with patients with persistent oligoarticular and ERA (P<.001). Sixty-six patients had nail changes associated with distal interphalangeal involvement (P=.0034).
“Time to first inactive disease on, but not off, therapy was significantly longer among patients with polyarticular course when compared to oligoarticular and ERA (P=.016 and P=.48, respectively),” the researchers reported.
Contractures during follow-up were more frequent for polyarticular patients compared with the other groups (P=.01).
“We suggest that JPsA may comprise four distinct groups that are similar to non-JPsA [juvenile idiopathic arthritis] regarding presentation, disease course, uveitis associations, response to treatment and outcome,” the researchers concluded. “If other large independent cohorts confirm our findings, then we suggest that the presence of psoriasis may have little clinical relevance in the outcome and response to therapy of children with JIA. Therefore we may consider psoriasis as an extra-articular manifestation seen in JIA, similar to uveitis, rather a feature requiring a distinct classification grouping.”
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