Juvenile Psoriatic Arthritis (JPsA) clinical features and outcome of 119 patients

Objective

To determine the long-term outcome of a single center cohort of children with JPsA.

Methods

Clinical records of 122 patients meeting the Vancouver or ILAR criteria for JPsA were reviewed. Patients were divided into 4 groups depending on their clinical features: a)Oligoarticular, b)RF(-) polyarticular, c)RF(+) polyarticular and d)enthesitis related arthritis (ERA). Patient characteristics and clinical features at onset and during follow-up were determined.

Results

The cohort consisted of 119 patients, 59(49.6%) had polyarticular course, 54(47.8%) were RF(-) and 4(3.3%) RF(+), 44 patients(38.3%) had oligoarticular course and 16(13.4%) ERA.

At diagnosis patients with ERA were older as compared to patients with oligoarticular and polyarticular course (11.6 ± 2.2 years vs 7.7 ± 4.3 years and 7.1 ± 4.5 years respectively p = 0.001).

Patients with polyarticular course had more MCP, PIP and wrist involvement when compared to patients with oligoarticular course and with ERA (p < 0.001 for all).

Patients with ERA had significantly more hip and sacroiliac involvement compared to the other groups (p < 0.001 for both).

Nail changes was seen in 66 patients (57%) and was associated with DIP involvement at presentation (p = 0.0034).

Outcome

Time to first inactive disease period on but not off therapy was significantly longer among patients with polyarticular disease when compared to the oligoarticular and the ERA groups (p = 0.016 and p = 0.48 respectively).

Patients with polyarticular had more contracture during follow-up when compared to patients with oligoarticular and with ERA (p = 0.01)

Conclusion

Patients with JPsA compromised from three distinct group of patients.

Most patients with JPsA will achieve inactive disease and only minority will have long lasting contracture.