ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis

Psoriatic juvenile idiopathic arthritis: Pathogenesis, clinical manifestations, and diagnosis
Literature review current through: Jan 2024.
This topic last updated: Dec 09, 2023.

INTRODUCTION — Psoriatic juvenile idiopathic arthritis (psJIA), or alternately juvenile psoriatic arthritis (JPsA), is a condition that can range widely in presentation and severity. Frank cutaneous psoriasis is not always evident, and the extent of articular involvement may vary from mild enthesitis (inflammation of sites at which ligaments, tendons, and other fibrous structures insert into bone) to polyarticular involvement of multiple axial (spine and sacroiliac joints) and peripheral joints.

The epidemiology, clinical manifestations, and diagnosis of psJIA are discussed here. The treatment and prognosis of psJIA, the pathogenesis of psoriatic arthritis, and psoriatic arthritis in adults are discussed separately. (See "Psoriatic juvenile idiopathic arthritis: Management and prognosis" and "Clinical manifestations and diagnosis of psoriatic arthritis" and "Treatment of psoriatic arthritis" and "Pathogenesis of psoriatic arthritis".)

EPIDEMIOLOGY — The prevalence of psJIA is not known with certainty, and there appears to be considerable geographic variation. A psoriatic diathesis is evident in children with JIA at a far higher rate than in the general pediatric population [1]. psJIA represents approximately 7 percent (range: 0 to 11 percent) of all patients with JIA in series that include only patients with frank psoriasis or using International League of Associations for Rheumatology (ILAR) criteria [2-15]. Series employing the more inclusive Vancouver criteria (see 'Diagnosis' below) suggest that psJIA represents 8 to 20 percent of JIA [2,5,6,16]. By contrast, psoriasis occurs in only approximately 0.5 to 1 percent of all children, rising to 2 to 3 percent in adulthood [17-19]. The incidence and prevalence of psJIA among children with psoriasis are not defined.

In the pediatric population, the age at onset of psJIA is bimodal [2,5,15,20]. A first peak (mainly in females) occurs during the preschool years and bears clinical similarity to early-onset oligoarticular JIA. The second peak is seen during middle to late childhood and resembles adult psoriatic arthritis. psJIA is very uncommon before the age of one year. (See 'Clinical manifestations' below.)

CLINICAL MANIFESTATIONS — psJIA is clinically diverse. Inflammation may involve only one joint or many, with or without involvement of the sacroiliac joints, spine, or peripheral entheses. Some of this variability in psJIA reflects divergent presentations in younger and older children. Younger children, presenting before the age of five to six years, are clinically similar in many ways to early-onset oligoarticular JIA. They are more likely to be female and to have a positive antinuclear antibody (ANA) titer [5,15,21]. Several features do distinguish these children from those with non-psJIA, including dactylitis (a sausage-like swelling of individual digits) and a tendency of the arthritis to involve the wrists and small joints of the hands and feet. Some patients progress to more widespread joint involvement [6,22-24]. Older children with psJIA, typically adolescents, exhibit a sex ratio closer to 1:1 and resemble adults with psoriatic arthritis. They tend to develop enthesitis and spinal or sacroiliac disease [3,5,15,21,25].

Arthritis — Arthritis in psJIA starts in fewer than five joints in approximately 80 percent of children (table 1). In some cases, children present with arthritis of a single joint, typically the knee, or with isolated dactylitis [21]. The most commonly involved joints are the knee and ankle, with hip joint disease in up to 20 to 30 percent (table 1). Wrists, ankles, and small joints of the hands and feet are more frequently affected than in other subtypes of oligoarthritis [2,5,6,22,23,26]. Arthritis of the distal interphalangeal joints (DIPs) is highly suggestive of psoriatic arthritis, although most children with psJIA lack DIP involvement. Extension of arthritis to five or more joints occurs in 60 to 80 percent of patients in the absence of effective therapy [2,21,26,27]. Even in polyarticular disease, the number of joints involved is often lower than in other forms of childhood-onset polyarthritis, giving rise to an asymmetric distribution of involved joints [2,28]. The highly destructive form of adult psoriatic arthritis known as arthritis mutilans is rare in children.

Arthritis of the spine and sacroiliac joints — psJIA may affect the axial skeleton in 10 to 30 percent of patients (table 1). Sacroiliitis, often asymmetric, principally affects patients with older age at onset who are often positive for the human leukocyte antigen (HLA) B27 antigen (image 1) [5,29]. Inflammatory disease of the lumbar spine occurs in less than 5 percent of children with psJIA and is typically milder than in ankylosing spondylitis, usually failing to progress to spinal ankylosis [2,5,26,30]. (See "Spondyloarthritis in children".)

Enthesitis — Enthesitis refers to inflammation localized to the insertion of ligaments, tendons, and other fibrous structures into bone. Typical sites of enthesitis include the insertions of the Achilles tendon and the plantar fascia into the calcaneus. Other sites readily accessible to examination include the poles of the patellae, the iliac crests, the medial femoral condyles, and the lateral epicondyles of the elbow [31,32]. Suspected enthesitis can be confirmed by ultrasound or magnetic resonance imaging (MRI) [33].

Enthesitis is a hallmark of adult psoriatic arthritis, but its role in children with psoriatic arthritis is less well established. Approximately 60 percent of children in the older subgroup of psJIA exhibit entheseal tenderness compared with 22 percent of younger patients, although the latter may be an underestimate since the exam is difficult in younger children [5]. Indeed, dactylitis is especially common in younger children with psJIA, and limited radiologic and histologic evidence suggests that enthesitis may contribute to its development [34]. (See 'Dactylitis' below.)

Many children with arthritis and enthesitis are classified as enthesitis related arthritis (ERA) using the International League of Associations for Rheumatology (ILAR criteria), although some of these patients are classified as psJIA if they fulfill appropriate criteria [14,18].

Dactylitis — Dactylitis refers to swelling within a digit that extends beyond the borders of the joints. Such swelling may be uniform along the length of the digit, giving the appearance of a "sausage digit," but it can also be fusiform with accentuation around the proximal interphalangeal (PIP) joint (picture 1 and image 2). Adult studies suggest that the dactylitic appearance results from a variable combination of flexor tenosynovitis, synovitis in the nearby joints, subperiosteal new bone growth, and enthesitis at the multiple insertions of tendons, ligaments, and other fibrous structures that enable flexion of the digits without bowstringing of the flexor tendons [35-38]. The histologic appearance remains poorly characterized, but a lymphocytic rather than neutrophilic infiltrate has been reported [34]. Dactylitis is observed in 20 to 40 percent of patients with psJIA (table 1) [26,39]. Commonly, only one or a few digits are affected, most often the second toe and index finger, possibly because of their length and, therefore, susceptibility to trauma. Dactylitis may be symptomatic or asymptomatic. In one series, dactylitis was the only musculoskeletal finding at presentation in 12 percent of children with psJIA [21]. Dactylitis is reported in up to 18 percent of children with non-psJIA, although it is possible that many of these children had unrecognized psJIA given the challenge of correctly diagnosing this condition [1,2,23,40].

Skin and nail disease — Overt psoriasis occurs in 40 to 60 percent of patients with psJIA, usually the classic vulgaris form, although guttate psoriasis is also observed [2,3,6,21,25,41,42]. Psoriasis in children tends to be subtle, with thin, soft plaques that may come and go, sometimes hidden in the hairline, umbilicus, behind the ears, or in the intergluteal crease (picture 2) [43,44]. The lesions may appear similar to eczema. Some lesions remain difficult to diagnose unambiguously, even with expert dermatologic examination [43].

Nail changes such as pitting are found in 50 to 80 percent of children with psJIA compared with up to 30 percent in childhood psoriasis in general (picture 1) [3,5,21,42,45,46]. Onycholysis (separation of the nail from the nail bed) may also be observed but is far less common. These nail changes may reflect enthesitis of the distal insertion of the extensor tendons, a site in intimate contact with the nail bed [47,48].

Uveitis — Chronic painless uveitis occurs in 6 to 15 percent of children with psJIA (table 1) and is indistinguishable from that seen in oligoarticular and polyarticular JIA [12,15,49,50]. Patients whose disease starts before age five years and who are ANA positive are at highest risk. In one series of 1862 patients with psJIA, uveitis was diagnosed in 73/423 (17 percent) with onset <5 years versus 49/1306 (4 percent) with later onset, and 60 percent of affected patients were ANA positive compared with 37 percent of children without uveitis [50]. Regular ophthalmologic screening is essential to prevent visual loss, and standard JIA uveitis screening guidelines apply. In one study, the rate of complications of uveitis was higher in psJIA than in other subtypes of juvenile arthritis [51]. Acute anterior uveitis characteristic of the adult spondyloarthropathies may occur in older children and is associated with the presence of HLA-B27, although chronic uveitis is also reported in this subgroup [3-5,52-54]. (See "Oligoarticular juvenile idiopathic arthritis", section on 'Uveitis'.)

Other systemic manifestations — Patients with psJIA are more likely to be overweight than children with other forms of arthritis, as is seen in adults with psoriatic arthritis [55]. Children with very active polyarticular psJIA may have the constitutional features of chronic inflammatory disease, including anorexia, anemia, and poor growth. Fever occurs rarely and only in exceptionally severe cases. Thus, fever should not be ascribed to psJIA without a careful search for alternate causes, including malignancy [41,56,57].

LABORATORY FINDINGS — psJIA, as with most other types of JIA, is a clinical diagnosis for which laboratory testing can neither exclude nor establish the diagnosis. Inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet count, may exhibit mild-to-moderate elevation but are often normal, even in active polyarticular disease [5,21]. Antinuclear antibody (ANA) is present at low or moderate titer in 60 percent of younger patients and 30 percent of older patients and is helpful primarily to define uveitis risk for the purpose of ophthalmologic screening [5]. Extractable nuclear antigens (eg, anti-double-stranded deoxyribonucleic acid [dsDNA], anti-Smith) are usually absent. Rheumatoid factor (RF) is typically negative and is considered an exclusion criterion under International League of Associations for Rheumatology (ILAR) definitions (table 2). The presence of psoriasis may be incidental in patients with symmetric polyarthritis who are positive at high titer for RF or anticyclic citrullinated peptide (CCP) antibodies. These rare patients are generally better considered to represent RF-positive polyarticular JIA [56].

RADIOLOGIC STUDIES — Bony changes and joint space narrowing, indicating significant cartilage loss, are typically evident only after disease has advanced substantially. Proliferative new bone formation is evident less often in children than in adults [58].

Magnetic resonance imaging (MRI) with gadolinium contrast enhancement can help define synovitis, effusions, tendinitis, enthesitis, and bone marrow edema in cases where the examination is ambiguous, although the specificity of particular radiologic findings for psJIA has not been determined [58]. Gadolinium contrast is not required for imaging of inflammation in the sacroiliac joints [59]. In experienced hands, ultrasound is a useful and cost-effective alternative to MRI, with the benefits of being less dependent on complete patient cooperation and more amenable to serial follow-up [33].

DIAGNOSIS — psJIA is diagnosed readily in children in whom joint inflammation develops in the setting of established psoriasis. However, the classic skin rash is absent at presentation in approximately half of children with psJIA, sometimes lagging 10 years or more behind onset of joint symptoms [2-6,21,22,25,26,41,42,52,60,61]. In addition, psoriasis in the young child may be subtle, atypical, and transient and is often initially misdiagnosed as eczema (picture 2) [3,41,43]. Diagnostic uncertainty is common but of limited clinical importance since treatment options for psJIA do not differ substantially from those employed in most other JIA subtypes. (See "Psoriatic juvenile idiopathic arthritis: Management and prognosis".)

In practice, psJIA is suspected when arthritis occurs in the setting of a personal or family history of psoriasis, in the presence of suggestive rashes, or when arthritis is accompanied by nail pits, onycholysis, or dactylitis, which are hallmarks of psoriasis-associated arthritis in both children and adults (picture 1 and picture 3). Additional clues include particular joint patterns, such as arthritis of the small joints of the hands or feet in the context of oligoarthritis (<5 joints total) or tenderness at entheseal sites [22,23,30]. When another type of JIA is strongly suspected, the presence of psoriasis or a family history of psoriasis may be incidental (for example, in a patient with high titers of rheumatoid factor [RF] or cyclic citrullinated peptide [CCP] autoantibodies indicating seropositive polyarticular JIA or with fever and evanescent rash indicating systemic JIA). (See 'Clinical manifestations' above and "Clinical manifestations and diagnosis of psoriatic arthritis".)

Laboratory tests and radiologic studies are of limited value in the diagnosis of psJIA, with the exception of magnetic resonance imaging (MRI) of the sacroiliac joints in patients with suspected sacroiliitis. (See 'Laboratory findings' above and 'Radiologic studies' above.)

Diagnostic criteria — Recognizing the diagnostic challenge, criteria have been developed to facilitate recognition of psJIA in the absence of frank psoriasis, incorporating such clues as family history of psoriasis and suggestive physical findings [2,62]. The older (Vancouver) criteria are more permissive than the subsequent consensus criteria from the International League of Associations for Rheumatology (ILAR), which incorporate extensive exclusion criteria to enable distinction from other ILAR JIA subtypes (table 2) [2,15,52,62]. Genetic data suggest a pathophysiologic continuum between childhood-onset and adult-onset psoriatic arthritis [63-66]. (See "Classification of juvenile idiopathic arthritis".)

DIFFERENTIAL DIAGNOSIS — The differential diagnosis of psJIA principally includes other subtypes of JIA, especially oligoarticular and polyarticular rheumatoid factor (RF) negative JIA and enthesitis related arthritis (ERA). Residual diagnostic uncertainty is common but fortunately has few treatment implications. (See "Classification of juvenile idiopathic arthritis" and "Oligoarticular juvenile idiopathic arthritis" and "Polyarticular juvenile idiopathic arthritis: Clinical manifestations, diagnosis, and complications" and "Psoriatic juvenile idiopathic arthritis: Management and prognosis".)

Beyond other types of JIA, the differential diagnosis depends upon presentation (see 'Clinical manifestations' above):

Monoarthritis and large-joint oligoarthritis raise the possibility of mechanical derangement or Lyme disease, which can be excluded by appropriate imaging and serologic assays when indicated. (See "Diagnosis of Lyme disease" and "Lyme disease: Clinical manifestations in children", section on 'Arthritis'.)

The differential diagnosis of polyarticular disease is principally restricted to polyarticular JIA (RF negative or positive) but includes infection with parvovirus B19 or other viruses, immune complex diseases including postinfectious arthritis and cryoglobulinemia, and vasculitis. These more unusual entities should be considered when disease onset is fulminant or accompanied by clinical features unexplained by psJIA, such as nonpsoriatic rashes or multisystem disease. (See "Clinical manifestations and diagnosis of parvovirus B19 infection" and "Overview of cryoglobulins and cryoglobulinemia" and "Vasculitis in children: Evaluation overview".)

Crystalline arthropathy, such as gout or pseudogout, is extremely rare in children but should be considered where there are risk factors such as renal dysfunction or the use of diuretics or calcineurin inhibitors. It can be excluded by serum assay for uric acid (for gout) and polarized light inspection of a joint aspirate. (See "Clinical manifestations and diagnosis of gout" and "Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease".)

Fever and severe pain raise consideration of septic arthritis or a musculoskeletal presentation of malignancy, in particular acute lymphoblastic leukemia and rarely lymphoma [67]. Clues to malignancy include migratory symptoms, bony pain not limited to the joints, fever, elevated inflammatory markers out of proportion to the extent of synovitis, or hematologic abnormalities such as marked anemia or a platelet count lower than expected for the degree and chronicity of systemic inflammation. (See "Bacterial arthritis: Clinical features and diagnosis in infants and children" and "Overview of the clinical presentation and diagnosis of acute lymphoblastic leukemia/lymphoma in children" and "Overview of common presenting signs and symptoms of childhood cancer", section on 'Bone and joint pain'.)

The differential diagnosis of digital swelling includes sickle cell disease, tuberculous osteomyelitis, and sarcoid arthropathy, but these are rarely confused with psJIA. (See "Overview of the clinical manifestations of sickle cell disease" and "Bone and joint tuberculosis" and "Sarcoid arthropathy".)

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Juvenile idiopathic arthritis" and "Society guideline links: Uveitis".)

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)

Basics topic (see "Patient education: Psoriatic arthritis in children (The Basics)")

SUMMARY

Clinical manifestations – Psoriatic juvenile idiopathic arthritis (psJIA), or juvenile psoriatic arthritis (JPsA), is clinically diverse (table 1). Inflammation may involve only one joint or many, with or without involvement of the sacroiliac joints, spine, or peripheral entheses. Dactylitis (a sausage-like swelling of individual digits) (picture 3) is a common manifestation in younger children, whereas axial arthritis and enthesitis (inflammation localized to the insertion of ligaments, tendons, and other fibrous structures into bone) are more common in older children. Frank cutaneous psoriasis is not always evident (picture 2). Nail pitting (picture 1) is seen more often in psJIA than in psoriasis restricted to the skin. (See 'Clinical manifestations' above.)

Laboratory findings – Rheumatoid factor (RF) is typically negative and is considered an exclusion criterion. Inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet count, may exhibit mild-to-moderate elevation but are often normal, even in active polyarticular disease. (See 'Laboratory findings' above.)

Radiologic studies – Bony changes and joint space narrowing, indicating significant cartilage loss, are typically evident only after disease has advanced substantially (image 2 and image 1). (See 'Radiologic studies' above.)

Diagnosis – psJIA is diagnosed readily in children in whom joint inflammation develops in the setting of established psoriasis (table 2). However, the classic skin rash is absent at presentation in approximately half of children with psJIA, sometimes lagging 10 years or more behind onset of joint symptoms. In addition, psoriasis in the young child may be subtle, atypical, and transient and is often initially misdiagnosed as eczema. Thus, diagnostic uncertainty is common. Laboratory tests and radiologic studies are of limited value in the diagnosis of psJIA. (See 'Diagnosis' above.)

Differential diagnosis – The differential diagnosis of psJIA principally includes other subtypes of JIA, especially oligoarticular and polyarticular RF-negative JIA and enthesitis related arthritis (ERA). Beyond other types of JIA, the differential diagnosis depends upon the clinical presentation. (See 'Differential diagnosis' above.)

  1. Nigrovic PA. Juvenile psoriatic arthritis: bathwater or baby? J Rheumatol 2009; 36:1861.
  2. Southwood TR, Petty RE, Malleson PN, et al. Psoriatic arthritis in children. Arthritis Rheum 1989; 32:1007.
  3. Truckenbrodt H, Häfner R. [Psoriatic arthritis in childhood. A comparison with subgroups of chronic juvenile arthritis]. Z Rheumatol 1990; 49:88.
  4. Koó E, Balogh Z, Gömör B. Juvenile psoriatic arthritis. Clin Rheumatol 1991; 10:245.
  5. Stoll ML, Zurakowski D, Nigrovic LE, et al. Patients with juvenile psoriatic arthritis comprise two distinct populations. Arthritis Rheum 2006; 54:3564.
  6. Flatø B, Lien G, Smerdel-Ramoya A, Vinje O. Juvenile psoriatic arthritis: longterm outcome and differentiation from other subtypes of juvenile idiopathic arthritis. J Rheumatol 2009; 36:642.
  7. Thomas E, Barrett JH, Donn RP, et al. Subtyping of juvenile idiopathic arthritis using latent class analysis. British Paediatric Rheumatology Group. Arthritis Rheum 2000; 43:1496.
  8. Hofer MF, Mouy R, Prieur AM. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol 2001; 28:1083.
  9. Krumrey-Langkammerer M, Häfner R. Evaluation of the ILAR criteria for juvenile idiopathic arthritis. J Rheumatol 2001; 28:2544.
  10. Berntson L, Fasth A, Andersson-Gäre B, et al. Construct validity of ILAR and EULAR criteria in juvenile idiopathic arthritis: a population based incidence study from the Nordic countries. International League of Associations for Rheumatology. European League Against Rheumatism. J Rheumatol 2001; 28:2737.
  11. Merino R, de Inocencio J, García-Consuegra J. Evaluation of revised International League of Associations for Rheumatology classification criteria for juvenile idiopathic arthritis in Spanish children (Edmonton 2001). J Rheumatol 2005; 32:559.
  12. Saurenmann RK, Levin AV, Feldman BM, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum 2007; 56:647.
  13. Arguedas O, Fasth A, Andersson-Gäre B, Porras O. Juvenile chronic arthritis in urban San José, Costa Rica: a 2 year prospective study. J Rheumatol 1998; 25:1844.
  14. Danner S, Sordet C, Terzic J, et al. Epidemiology of juvenile idiopathic arthritis in Alsace, France. J Rheumatol 2006; 33:1377.
  15. Zisman D, Gladman DD, Stoll ML, et al. The Juvenile Psoriatic Arthritis Cohort in the CARRA Registry: Clinical Characteristics, Classification, and Outcomes. J Rheumatol 2017; 44:342.
  16. Oen K, Fast M, Postl B. Epidemiology of juvenile rheumatoid arthritis in Manitoba, Canada, 1975-92: cycles in incidence. J Rheumatol 1995; 22:745.
  17. Ferrándiz C, Bordas X, García-Patos V, et al. Prevalence of psoriasis in Spain (Epiderma Project: phase I). J Eur Acad Dermatol Venereol 2001; 15:20.
  18. Gelfand JM, Weinstein R, Porter SB, et al. Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol 2005; 141:1537.
  19. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004. J Am Acad Dermatol 2009; 60:218.
  20. Stoll ML, Nigrovic PA. Subpopulations within juvenile psoriatic arthritis: a review of the literature. Clin Dev Immunol 2006; 13:377.
  21. Shore A, Ansell BM. Juvenile psoriatic arthritis--an analysis of 60 cases. J Pediatr 1982; 100:529.
  22. Huemer C, Malleson PN, Cabral DA, et al. Patterns of joint involvement at onset differentiate oligoarticular juvenile psoriatic arthritis from pauciarticular juvenile rheumatoid arthritis. J Rheumatol 2002; 29:1531.
  23. Stoll ML, Nigrovic PA, Gotte AC, Punaro M. Clinical comparison of early-onset psoriatic and non-psoriatic oligoarticular juvenile idiopathic arthritis. Clin Exp Rheumatol 2011; 29:582.
  24. Petty RE. Juvenile psoriatic arthritis, or juvenile arthritis with psoriasis? Clin Exp Rheumatol 1994; 12 Suppl 10:S55.
  25. Hamilton ML, Gladman DD, Shore A, et al. Juvenile psoriatic arthritis and HLA antigens. Ann Rheum Dis 1990; 49:694.
  26. Roberton DM, Cabral DA, Malleson PN, Petty RE. Juvenile psoriatic arthritis: followup and evaluation of diagnostic criteria. J Rheumatol 1996; 23:166.
  27. Ekelund M, Aalto K, Fasth A, et al. Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year follow-up study. Pediatr Rheumatol Online J 2017; 15:13.
  28. Helliwell PS, Hetthen J, Sokoll K, et al. Joint symmetry in early and late rheumatoid and psoriatic arthritis: comparison with a mathematical model. Arthritis Rheum 2000; 43:865.
  29. Ansell B, Beeson M, Hall P, et al. HLA and juvenile psoriatic arthritis. Br J Rheumatol 1993; 32:836.
  30. Helliwell PS, Hickling P, Wright V. Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis? Ann Rheum Dis 1998; 57:135.
  31. D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, et al. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum 2003; 48:523.
  32. Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum 2008; 59:686.
  33. Kamel M, Eid H, Mansour R. Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging. J Rheumatol 2003; 30:774.
  34. Tuttle KS, Vargas SO, Callahan MJ, et al. Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity. Pediatr Rheumatol Online J 2015; 13:7.
  35. Olivieri I, Barozzi L, Favaro L, et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum 1996; 39:1524.
  36. Olivieri I, Salvarani C, Cantini F, et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum 2002; 46:2964.
  37. Lalande Champetier de Ribes T, Margarit-Coll N, Sans N, et al. [Ultrasound features of entesopathy in patients with psoriatic dactylitis]. J Radiol 2006; 87:639.
  38. Healy PJ, Groves C, Chandramohan M, Helliwell PS. MRI changes in psoriatic dactylitis--extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology (Oxford) 2008; 47:92.
  39. Padula A, Belsito F, Barozzi L, et al. Isolated tenosynovitis associated with psoriasis triggered by physical injury. Clin Exp Rheumatol 1999; 17:103.
  40. Butbul YA, Tyrrell PN, Schneider R, et al. Comparison of patients with juvenile psoriatic arthritis and nonpsoriatic juvenile idiopathic arthritis: how different are they? J Rheumatol 2009; 36:2033.
  41. Lambert JR, Ansell BM, Stephenson E, Wright V. Psoriatic arthritis in childhood. Clin Rheum Dis 1976; 2:339.
  42. Sills EM. Psoriatic arthritis in childhood. Johns Hopkins Med J 1980; 146:49.
  43. Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol 2001; 18:188.
  44. Farber EM, Carlsen RA. Psoriasis in childhood. Calif Med 1966; 105:415.
  45. Kumar B, Jain R, Sandhu K, et al. Epidemiology of childhood psoriasis: a study of 419 patients from northern India. Int J Dermatol 2004; 43:654.
  46. Al-Mutairi N, Manchanda Y, Nour-Eldin O. Nail changes in childhood psoriasis: a study from Kuwait. Pediatr Dermatol 2007; 24:7.
  47. Scarpa R, Soscia E, Peluso R, et al. Nail and distal interphalangeal joint in psoriatic arthritis. J Rheumatol 2006; 33:1315.
  48. Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis--a high-resolution MRI and histological study. Rheumatology (Oxford) 2007; 46:253.
  49. Heiligenhaus A, Niewerth M, Ganser G, et al. Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford) 2007; 46:1015.
  50. Baquet-Walscheid K, Rothaus K, Niewerth M, et al. Occurrence and Risk Factors of Uveitis in Juvenile Psoriatic Arthritis: Data From a Population-based Nationwide Study in Germany. J Rheumatol 2022; 49:719.
  51. Cabral DA, Petty RE, Malleson PN, et al. Visual prognosis in children with chronic anterior uveitis and arthritis. J Rheumatol 1994; 21:2370.
  52. Stoll ML, Lio P, Sundel RP, Nigrovic PA. Comparison of Vancouver and International League of Associations for rheumatology classification criteria for juvenile psoriatic arthritis. Arthritis Rheum 2008; 59:51.
  53. Paiva ES, Macaluso DC, Edwards A, Rosenbaum JT. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis 2000; 59:67.
  54. Häfner R, Michels H. Psoriatic arthritis in children. Curr Opin Rheumatol 1996; 8:467.
  55. Samad A, Stoll ML, Lavi I, et al. Adiposity in Juvenile Psoriatic Arthritis. J Rheumatol 2018; 45:411.
  56. WRIGHT V. Rheumatism and psoriasis: a re-evaluation. Am J Med 1959; 27:454.
  57. Nordstrom BL, Mines D, Gu Y, et al. Risk of malignancy in children with juvenile idiopathic arthritis not treated with biologic agents. Arthritis Care Res (Hoboken) 2012; 64:1357.
  58. Lee EY, Sundel RP, Kim S, et al. MRI findings of juvenile psoriatic arthritis. Skeletal Radiol 2008; 37:987.
  59. Weiss PF, Xiao R, Biko DM, et al. Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary? Arthritis Rheumatol 2015; 67:2250.
  60. Calabro JJ. Psoriatic arthritis in children. Arthritis Rheum 1977; 20 Suppl:415.
  61. Wesołowska H. Clinical course of psoriatic arthropathy in children. Mater Med Pol 1985; 17:185.
  62. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31:390.
  63. Hinks A, Martin P, Flynn E, et al. Subtype specific genetic associations for juvenile idiopathic arthritis: ERAP1 with the enthesitis related arthritis subtype and IL23R with juvenile psoriatic arthritis. Arthritis Res Ther 2011; 13:R12.
  64. Hinks A, Bowes J, Cobb J, et al. Fine-mapping the MHC locus in juvenile idiopathic arthritis (JIA) reveals genetic heterogeneity corresponding to distinct adult inflammatory arthritic diseases. Ann Rheum Dis 2017; 76:765.
  65. Nigrovic PA, Raychaudhuri S, Thompson SD. Review: Genetics and the Classification of Arthritis in Adults and Children. Arthritis Rheumatol 2018; 70:7.
  66. Nigrovic PA, Colbert RA, Holers VM, et al. Biological classification of childhood arthritis: roadmap to a molecular nomenclature. Nat Rev Rheumatol 2021; 17:257.
  67. Cabral DA, Tucker LB. Malignancies in children who initially present with rheumatic complaints. J Pediatr 1999; 134:53.
Topic 16630 Version 15.0

References

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟