Patient education: Psoriatic arthritis in children (The Basics)

What is psoriatic arthritis in children? — Arthritis is a general term that means inflammation of the joints. Psoriatic arthritis is one type of arthritis. It happens most often in children who have a skin condition called psoriasis. Psoriasis causes patches of thick, red 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.

The medical terms for this condition are "psoriatic juvenile idiopathic arthritis" and "juvenile psoriatic arthritis."

What are the symptoms of psoriatic arthritis in children? — 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 a child's age. Children younger than 5 or 6 years often have swelling of their fingers or toes. This makes the fingers or toes look like sausages (picture 1).

Older children and teens often have joint pain in their back or hips. They also sometimes have swelling in the 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:

●A psoriasis rash – This looks like red, raised patches of skin. These areas are sometimes hard to see because they might be in the hairline or behind the ears (picture 2).

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

●Eye redness – This is usually painless, but the cause of the redness is a condition called "uveitis," which can be serious. Uveitis can lead to vision loss, so make sure to mention this symptom to your child's doctor.

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

●Blood tests

●X-rays of the affected joints

Children with juvenile idiopathic arthritis will also need to see an eye doctor to check for uveitis. Often, uveitis does not cause symptoms until it has damaged the eye. That's why it's important to get regular eye exams.

How is psoriatic arthritis in children treated? — There is no cure for this condition, but different treatments can help ease and control symptoms. Treatment for psoriatic arthritis is usually long-term. Depending on your child's symptoms and other factors, treatment usually involves 1 or more of the following:

●Medicines called nonsteroidal antiinflammatory drugs, or "NSAIDs" for short – NSAIDs are a large group of medicines that includes ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve).

●Shots of steroid medicines that go into the painful joint – These are not the same as the steroids some athletes take illegally. These steroids help reduce swelling and pain.

●Medicines called disease-modifying antirheumatic drugs, or "DMARDs" – These include methotrexate, sulfasalazine, or leflunomide, which come as pills or liquid. "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).

Is there anything my child can do on their own to feel better? — Yes. It is very important for your child to stay active. They might want to avoid being active because of pain. But this can make things worse. It can make the muscles weak and the 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's hard to know, because 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: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Uveitis (The Basics)
Patient education: Side effects from medicines (The Basics)
Patient education: Brand versus generic medicines (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)