Patient education: Psoriatic arthritis in children (The Basics)

What is psoriatic arthritis in children? — 

Arthritis means inflammation of the joints. Psoriatic arthritis is 1 type of arthritis. It happens most often in children who have a skin condition called "psoriasis." This causes patches of thick, red or dark skin that are sometimes covered by silver or white scales.

Sometimes, psoriatic arthritis happens in children who don't have the psoriasis rash, but who have family members with psoriasis. Doctors don't know what causes psoriatic arthritis in children.

Psoriatic arthritis is also sometimes called "psoriatic juvenile idiopathic arthritis" ("psoriatic JIA") and "juvenile psoriatic arthritis."

What are the symptoms of psoriatic arthritis in children? — 

The symptoms are not the same in all children. In general, psoriatic arthritis causes joint pain and swelling. Joints that are commonly affected include those in the knees, ankles, hips, wrists, hands, and feet.

Symptoms also sometimes depend on the child's age. Children younger than 5 or 6 years often have swelling of their fingers or toes (picture 1). This makes the fingers or toes look like sausages.

Older children and teens often have joint pain in their back or hips. They also sometimes have swelling in their lower leg or around their ankles. The swelling happens where strong bands of tissue (called tendons and ligaments) attach to bones.

In addition to joint symptoms, children with psoriatic arthritis sometimes have:

●Psoriasis rash (picture 2) – This looks like raised patches of skin. The patches might be red, purple, brown, or gray. They are sometimes covered with silver or white scales or flakes. These areas are sometimes hard to see because they might be in the hairline or behind the ears.

●Nail changes (picture 3) – The nails can look "pitted," as if they were pricked by a pin. The nail can also come up off the nail bed.

●Eye inflammation – Inflammation in the front part of the eye, called "uveitis," can be serious and lead to vision loss. Often, uveitis does not cause symptoms until it has damaged the eye. An eye doctor (called an "ophthalmologist") can check for uveitis during a special eye exam.

Will my child need tests? — 

To figure out what's causing your child's symptoms, the doctor or nurse will ask about their symptoms and do an exam. They might also order:

●Blood tests

●X-rays of the affected joints

Children with psoriatic arthritis also need to see an eye doctor to check for uveitis. Since uveitis might not cause any symptoms, it's important to get regular eye exams.

How is psoriatic arthritis in children treated? — 

There is no cure, but different treatments can help with symptoms. Treatment is usually long term.

Depending on your child's symptoms and other factors, treatment usually involves 1 or more of these medicines:

●Nonsteroidal antiinflammatory drugs ("NSAIDs") – This is a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). Never give aspirin to a child younger than 18 years old.

●Shots of steroid medicines into the painful joint – These help reduce swelling and pain.

●Disease-modifying antirheumatic drugs ("DMARDs") – These include methotrexate, sulfasalazine, and leflunomide. They come as pills or liquids. "Biologic" medicines are another type of DMARD. These are given as a shot that goes under the skin, or through an "IV" (a thin tube that goes into a vein).

What can my child can do on their own to feel better? — 

It is very important for them to stay active. They might want to avoid being active because of pain. But this can make things worse. It can make their muscles weak and their joints stiff. The doctor, nurse, or physical therapist can help figure out which activities and exercises are right for your child.

Will my child have long-term joint damage? — 

It depends on many factors. But the best way to help prevent long-term joint damage is to start treatment as soon as possible.

More on this topic

Patient education: Psoriasis (The Basics)
Patient education: Physical activity for people with arthritis (The Basics)
Patient education: Uveitis (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Steroid injection (The Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) (The Basics)
Patient education: Psoriatic arthritis in adults (The Basics)

Patient education: Psoriatic arthritis (Beyond the Basics)
Patient education: Psoriasis (Beyond the Basics)
Patient education: Arthritis and exercise (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)