Psoriatic Arthritis in Children and Teens

Psoriatic arthritis (PsA) is a rare autoimmune disease that affects the skin and joints. It is linked with a skin disorder called psoriasis. Psoriasis causes red, scaly rashes on the body. PsA can occur in adults and children. When PsA occurs in children under the age of 16, it is called juvenile psoriatic arthritis.¹

Children with PsA are usually diagnosed between the ages of 9 and 15. About 1 out of every 3 children with psoriasis will have PsA.^2,3

What causes PsA in children?

The exact cause of PsA is unknown. Genetics, the environment, and immunity all play a role. Children with a family history are more at risk. Forty to 80 percent of children with PsA have a close relative, such as a sibling, or parent.^1,3

Some experts believe an infection can trigger PsA in those with a genetic predisposition. But more research is needed to confirm this idea.²

Symptoms of PsA in children

The symptoms of PsA in children and teens are similar to those in adults. They can vary from person to person, ranging from mild to severe. They can include:^1-3

• Joint pain – Some kids may complain of pain in their joints or muscles after strenuous activity. But for most children with PsA, the pain is more noticeable first thing in the morning or after a nap. The pain may lessen with movement throughout the day.
• Stiffness – PsA can cause stiffness in the joints, often in the morning. A child may hold their arm or leg in a stiff position or walk with a limp. The stiffness is generally worse right after waking up.
• Swelling – PsA in children can cause swelling or redness on the skin around painful joints. Joints may feel warm to the touch.
• Swollen fingers and toes – Swollen, sausage-like fingers and toes can occur in children with PsA. It is more common in girls.
• Skin rash or lesions – Flaky, red rash or lesions may appear before or after joint problems.
• Eye pain – Swelling, redness, and an inflamed middle layer of the eye (uveitis) can occur in children with PsA.

Diagnosis of PsA in children

Diagnosing PsA in children may be difficult if they do not already have psoriasis. There is no single blood test to diagnose PsA in children. Diagnosis involves a variety of tests:^1-3

• A physical exam
• Family medical history
• Imaging tests to look at the joints (X-rays, MRI, ultrasound)
• Lab tests (complete blood count, antibody blood tests)

Treating PsA in children

The goal of treatment is to reduce inflammation, control pain, and improve the child’s quality of life. There is no cure for juvenile psoriatic arthritis. But treatment can increase the periods of time when there are no symptoms (remission). Treatment involves a combination of medication, physical activity, and a healthy diet.^1-3

Medicines

Several of the treatment options used in adults with PsA are approved by the U.S. Food and Drug Administration (FDA) for use in children with PsA, including ^1-3

• Non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation
• Corticosteroid injections to help ease redness and swelling
• Disease-modifying anti-rheumatic drugs (DMARDS) to help with psoriasis symptoms
• Biologic medicines to help improve arthritis and reduce skin inflammation from psoriasis

Lifestyle changes

Parents of children with PsA should help their child manage their condition through lifestyle changes and self-care. This means:^1-3

• Getting plenty of rest
• Staying active
• Reducing stress
• Eating a healthy diet
• Dealing with the emotional aspects of the disease

PsA can be a challenging condition in children, but there are treatment options available to support them. Regular monitoring and check-ups with their healthcare team can help ease and manage symptoms.