Juvenile psoriatic arthritis--an analysis of 60 cases

Sixty children who were considered to have juvenile psoriatic arthritis were analyzed retrospectively; the mean length of follow-up was 10.8 years. There was a female predominance of 3:2. The mean age at onset for both the psoriasis and the arthritis was between 8 and 9 years. A family history of psoriasis was present in almost half, and was a valuable clue in diagnosing the 26 of 60 who presented with arthritis first. The majority had a monarticular presentation, usually of the knee. Additional joints usually became involved sporadically in an asymmetric pattern, in both upper and lower limbs, so that 87% ultimately had polyarticular disease. This course is unlike the usual one of childhood arthritis. Although 40% were asymptomatic at follow-up, six patients required bilateral hip replacement, four within the first five years following the onset of arthritis. Sixteen patients received slow-acting drugs, usually gold; eight of these had had a polyarticular onset and seven a positive test for ANA.