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Updated: Mar 7, 2026
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year
Maria Ekelund1,2, Kristiina Aalto3, Anders Fasth4
1Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
Insights
Psoriasis in juvenile idiopathic arthritis (JIA) is linked to more severe disease and difficulty achieving remission. Early identification of psoriasis features is crucial for better JIA classification and treatment.
Area of Science:
- Pediatric Rheumatology
- Dermatology
- Immunology
Background:
- Juvenile idiopathic arthritis (JIA) is a complex autoimmune condition affecting children.
- Psoriasis and its associated features can influence JIA presentation and prognosis.
- Understanding this comorbidity is vital for accurate diagnosis and management.
Purpose of the Study:
- To investigate the impact of psoriasis on JIA classification and long-term outcomes.
- To analyze specific psoriasis-related features in a pediatric JIA cohort.
- To assess the relationship between psoriasis, JIA classification, and remission rates.
Main Methods:
- Prospective follow-up of 440 children with JIA for a median of 8 years.
- Assessment of psoriasis, psoriasis-like rash, dactylitis, nail pitting, and heredity.
- Evaluation of International League of Associations for Rheumatology (ILAR) classification and remission status.
Main Results:
- Psoriasis-associated features developed over the 8-year follow-up period.
- Children with psoriasis or rash had significantly more affected joints (median 11 vs. 6).
- Psoriasis, rash, or specific associated features increased the odds of not achieving remission (OR 3.32).
Conclusions:
- Psoriasis-associated JIA demonstrates a more severe disease course over time.
- Psoriasis features emerging during JIA pose challenges for current classification systems.
- Improved classification is needed for early, targeted treatment of these patients.
Background:
To study the impact of psoriasis and features associated with psoriasis on classification and outcome in a population-based follow-up cohort of children with juvenile idiopathic arthritis (JIA).
Methods:
In all, 440 children with JIA were followed for a median of 8 years in a prospective Nordic population-based cohort study. Data for remission was available for 427 of these children. The presence of psoriasis, psoriasis-like rash, dactylitis, nail pitting, enthesitis, tenosynovitis and heredity was assessed in relation to ILAR classification and remission.
Results:
Clinical findings associated with psoriasis developed consecutively during the 8-year period. Six of 14 children with psoriasis were not classified as juvenile psoriatic arthritis according to the ILAR criteria at 8 year follow-up. Dactylitis was more common in children with early onset of JIA. After 8 years we found a cumulative median number of eleven arthritic joints in children with psoriasis or psoriasis-like rash compared with six in the rest of the cohort (p = 0.02). Also, the chance for not being in remission after 8 years increased significantly in patients with psoriasis, psoriasis-like rash or at least two of: 1) first-degree heredity for psoriasis or psoriatic arthritis, 2) dactylitis or 3) nail pitting, compared with the rest of the group (OR 3.32, p = 0.010).
Conclusions:
Our results indicate a more severe disease over time in psoriasis-associated JIA, as features of psoriasis develop during the disease course. This group is a major challenge to encompass in a future JIA classification in order to facilitate early tailored treatment.
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