Overview
Juvenile psoriatic arthritis (JPsA) is a chronic inflammatory arthritis associated with psoriasis in children and adolescents, characterized by joint inflammation and skin lesions 1.Diagnosis
Presence of arthritis and psoriasis in pediatric patients 1.
Skin examination for psoriatic plaques, often with characteristic morphology 1.
Radiological assessment to evaluate joint damage and inflammation 1.
Laboratory tests including ESR, CRP, and RF/anti-CCP antibodies, though often negative 1.Management
First-line treatments: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1.
Disease-modifying antirheumatic drugs (DMARDs): Methotrexate is commonly used, typically starting at 10-15 mg/m2 weekly 1.
Adjunctive therapies: Biologic agents such as TNF inhibitors (e.g., adalimumab, etanercept) for refractory cases 1.
Skin management: Topical therapies and phototherapy for psoriatic skin lesions 1.Special Populations
Pediatrics: Close monitoring for methotrexate toxicity, particularly skin manifestations like ulcerated plaques 1.Key Recommendations
Monitor for early signs of methotrexate toxicity, including ulcerated psoriatic plaques, especially in pediatric patients (Evidence: Weak) 1.
Initiate treatment with NSAIDs for symptomatic relief in JPsA (Evidence: Expert opinion) 1.
Consider early escalation to biologic DMARDs in patients with inadequate response to conventional DMARDs like methotrexate (Evidence: Moderate) 1.References
1 Wong SM, Chong YT, Thevarajah S, Baba R. Methotrexate toxicity presenting as ulcerated psoriatic plaques. The Australasian journal of dermatology 2012. link