Management of psoriatic arthritis in children

Psoriatic arthritis affects 15% of children with chronic rheumatic joint disease. Aim of the study. To evaluate articular prognosis in 9 children (6-16 years) diagnosed with psoriatic arthritis and treated with different therapeutic agents, related to the degree severity of the cutaneous involvement. Results. Sex ratio in the study group was girls/boys = 3/6. 1st degree relatives with psoriasis were found in 5/9 cases. Poliarticular juvenile arthritis with multiple localizations (small distal hand and feet joints, radiocarpal, tibiotarsian joints) were found in 6 cases; the other 3 patients had extensive oligoarthritis (no identified HLA B27 association). None of the patients had ankyloses or severe functional motor deficiency. PASI score <10 was found in 4 children. Specific therapy consisted of methotrexate (2 patients) and association between methotrexate and etanercept (7 patients); All 9 children received local topical therapy. After 6-month treatment, the evaluation of patients who have received methotrexate associated with etanercept found ACR Pedi 30 response in 4 children and ACR Pedi 50 in 3 cases; PASI score was lower than 10 in 5 of these children. The 2 patients under methotrexate monotherapy showed neither ACR Pedi 30 response, nor improvement of the cutaneous symptoms after 6 months of treatment, so etanercept was added to methotrexate. The 12-month evaluation showed ACR Pedi 30 response in all 9 children; ACR Pedi 50 response in 6 children; PASI < 10 in 7 children. Conclusions. Early introduction of etanercept in addition to methotrexate seems to improve the prognosis of psoriatic arthritis, as well as skin disease, aspects that clearly ensure optimization of the quality of life of these patient.