Children and teens can develop arthritis, a condition characterized by inflammation of the joints. One subtype is called juvenile psoriatic arthritis. This article describes the causes, symptoms, diagnosis, and treatment of juvenile psoriatic arthritis.
Arthritis that develops in children is known as juvenile idiopathic arthritis. There are six different subtypes of Juvenile Idiopathic Arthritis, including a subtype known as Juvenile Psoriatic Arthritis. As the name suggests, this subtype develops in children with psoriasis, a skin disease characterized by the development of red, scaly rashes. About a third of all children with psoriasis will develop juvenile idiopathic arthritis.
In about 50 percent of children with juvenile psoriatic arthritis, arthritis symptoms begin before psoriasis onset, while in the remaining 50 percent, psoriasis symptoms precede arthritis. Juvenile psoriatic arthritis develops in both boys and girls and can occur at any age. In general, the disease only affects a few joints, particularly the joints located in the hips, back, fingers, and toes.
Juvenile psoriatic arthritis: causes
It is not currently known what causes the development of juvenile psoriatic arthritis. However, researchers know that this disease is the result of a malfunction of the immune system and is therefore an autoimmune disease. The immune system plays an important role in protecting us and our bodies from pathogens by attacking substances that they recognize as foreign and that do not belong in the body. However, in the case of an autoimmune disease, the immune system becomes confused and begins to identify healthy body tissue as foreign. Inflammation is a key mark of autoimmune diseases and therefore arthritis patients will have inflammation and inflammation of the joints.
Although we know that juvenile psoriatic arthritis is an autoimmune disease, it is not clear what triggers this immune system malfunction. Studies point to a role for both genetics and environmental factors in activating the immune system. Environmental triggers that lead to the development of psoriasis include stress, skin lesions, certain medications, infections, diet, allergies, and the weather.
Symptoms of Juvenile Psoriatic Arthritis
While the joints affected and the severity of symptoms vary from one individual to another, certain symptoms are common in all patients. Juvenile psoriatic arthritis patients may experience these symptoms:
- Inflammation, stiffness, pain, and swelling of the joints.
- Extreme swelling of the finger or toe joints, may appear “like sausage.”
- Joint stiffness is particularly severe in the morning.
- Depressions on the surface of the nail (a condition called boneless nails).
- Fatigue or weakness
- Inflammation of the eye (a disease called uveitis).
- Decreased range of motion of the joints.
- Red-appearing skin rash on the trunk, joints, face, or scalp. Sometimes the rash can be itchy.
Diagnosis: How your doctor knows
If your child’s doctor suspects that he has juvenile psoriatic arthritis, she will refer him to a specialist known as a rheumatologist. Unfortunately, there is no single test that can prove the presence of juvenile psoriatic arthritis, so the rheumatologist will make a diagnosis based on a variety of different things.
The rheumatologist will ask detailed questions about the symptoms, such as when they started, exactly what they are, how long they last, and others. The rheumatologist will also review her personal and family medical history and then perform a complete physical exam. The rheumatologist may also order tests to obtain additional evidence that the patient has juvenile psoriatic arthritis. These tests include:
- Blood tests, to detect markers of inflammation and the presence of certain antibodies that are very high in autoimmune diseases. This test can tell the physician that the patient likely has an autoimmune disease.
- Imaging tests, such as X-rays or MRIs, which can help visualize joint damage.
The urine test, as a substance called uric acid, is elevated in the urine of children with this disease
- Eye exam, as children with juvenile psoriatic arthritis are more likely to develop eye inflammation.
Treatment: how is it managed?
Since there are no treatments that can cure juvenile psoriatic arthritis, doctors will administer therapies to help relieve symptoms. Medications to help relieve symptoms include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reduce inflammation and pain.
- Biological therapy, drugs that attack the immune system and help relieve inflammation. For example, TNF inhibitors are a type of biological therapy that suppresses the activities of TNF-alpha, which is a pro-inflammatory molecule.
- Disease-modifying antirheumatic drugs (DMARDs) suppress the immune system and relieve symptoms.
However, biological therapy and FArME are still under investigation and therefore are not approved for the treatment of juvenile psoriatic arthritis. Other non-medical treatments for juvenile psoriatic arthritis include:
- Physical therapy. Patients can work with a physical therapist to learn strategies for movement and exercise to help them maintain their range of motion.
- Exercise. Exercising regularly can help children with this disease stay flexible and increase the strength of their joints.
- Occupational therapy. Working with an occupational therapist can help children with everyday tasks.
- Hydrotherapy. This type of therapy involves using a heated pool for exercise and has been shown to help strengthen joints and increase flexibility.