For Parents – Psoriatic Arthritis Treatment

Children and teens can get arthritis too. Psoriatic (sore-er-AT-ic) arthritis or PsA is one of seven sub-types of Juvenile Idiopathic Arthritis that cause inflammation and swelling of the joints and affects less than 1% of youth with psoriasis. Treatments are available that help reduce symptoms to achieve either low disease activity or remission – meaning the disease is no longer as severe.

Learn more about psoriatic arthritis in youth
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Treatment for juvenile psoriatic arthritis or JPsA will depend on your child’s age and weight, symptoms and severity of the arthritis, area affected, and overall health. Treatments for JPsA include oral systemics (most often in the form of a pill) and biologics or biosimilars that are given as an injection or infusion. Medications used for psoriatic arthritis target specific parts of your child’s immune system to reduce symptoms and inflammation and slow or prevent the progression of joint damage. Because few treatments have been approved for children and teens, your child’s health care provider may consider other options. Clinical trials continue to explore treatment options to help expand what medications can be used for children and teens. The goal of treatment is to reduce or prevent joint damage. Once joint damage occurs it is irreversible.

More treatments are available now for juvenile psoriatic arthritis than ever before.

Current Treatment Options Include:

Pain Relievers and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen may be suggested by your child’s health care provider to help ease pain and reduce swelling related to PsA. Talk with your child’s health care provider about the dosage which is based on the age and weight of your child, as well as if such medications are appropriate for your child if related health conditions are present.

Corticosteroids

Corticosteroids can be used in children and are given by pills or injection into an affected joint to help lower inflammation and reduce pain and swelling. The response occurs quickly and can last for months, however, corticosteroid injections are considered a short-term relief for severe disease flares. Corticosteroids can be used while waiting for oral systemics or biologics to take effect.

Oral Systemics

Oral systemics are medications that work more broadly throughout the body or target specific cells or parts of cells to reduce inflammation and swelling related to arthritis. Such medications may take several weeks or longer before relief occurs so other medications such as NSAIDs may be used in combination with oral systemics. Examples of oral systemics include methotrexate, cyclosporine, leflunomide, or sulfasalazine. Methotrexate is the most commonly used treatment, with folic acid supplementation recommended.

Biologics and Biosimilars

Biologics and biosimilars are medications that target specific proteins in the immune system that play a role in the development of psoriasis and psoriatic arthritis. A biosimilar is a product similar to an already approved biologic with no meaningful differences. This biologic is called the reference product. Interchangeable means the biosimilar meets other requirements by law and can be substituted for the reference product. By targeting specific proteins, biologics inhibit or block parts of the immune system that cause inflammation and swelling. Biologics may offer relief within a few weeks and are given either by injection or intravenous (IV) infusion. Examples of such medications used to treat active psoriatic arthritis in children and teens include:

Tumor necrosis factor (TNF) inhibitor:

  • Simponi Aria (golimumab), approved in 2020, inhibits TNF-alpha and is given in a doctor’s office by intravenous infusion in children ages 2 years and older.
  • Enbrel (etanercept), approved in 2023, inhibits TNF-alpha and is given by subcutaneous injection in children ages 2 years and older.

Interleukin-17 (IL-17A) inhibitor:

  • Cosentyx (secukinumab), approved in 2021, inhibits IL-17A and is given by subcutaneous injection in children ages 2 years and older. 

Interleukin-12/23 (IL-12/23):

  • Stelara (ustekinumab), approved in 2022, inhibits IL-12/23 and is given by subcutaneous injection in children ages 6 years and older. 
  • Wezlana (ustekinumab-auub) is an interchangeable biosimilar to Stelara (ustekinumab). Approved in 2023, Wezlana can be used in children ages 6 years and older.

T-cell inhibitor:

  • Orencia (abatacept), approved in 2023, blocks T-cell activity and is given as an injection or infusion in children ages 2 years and older. It can be used either alone or with methotrexate.

Other Treatment Options

In addition to medication other treatment options to discuss with your child’s health care providers may include:

  • Alternating for 10 minutes each between hot and cold packs to help reduce swelling and inflammation.
  • Exercise like stretching or strength building helps keep joints from becoming stiff and prevents loss of function. Swimming can help improve mobility and ease pain.
  • Talk with your child’s health care provider about a referral or prescription to a physical therapist. Physical therapy to help improve range of motion and joint and muscle function. A physical therapist can be part of your child’s health care team to develop a plan that can be done at home to help decrease pain and improve joint function.

Speak with your child’s health care provider with your child present about what the treatment will do, how often they need to take it, how long the treatment will take to have an effect, what the benefits and risks are, and if any lab work is needed to monitor sides effects from the medication. Depending on your child’s age, talk with them about their treatment preference. Do they prefer a pill, injection, or infusion? Younger children may do better with an injection instead of struggling to swallow a pill up to twice a day.

It is important to maintain a treatment plan as prescribed by your child’s rheumatologist or health care provider. Remember: the goal of treatment for psoriatic arthritis is to reduce or prevent joint damage. Keep in mind that by reducing inflammation through treatment, psoriasis, if present, should also improve.

Tips to Help Your Child Live Healthy with Psoriatic Arthritis

The best action is to help your child maintain a treatment plan. Keep follow-up appointments and maintain a treatment plan as prescribed by your child’s rheumatologist or health care provider. This will help reduce the inflammation that is causing the psoriatic arthritis and joint symptoms. If symptoms have not improved or if a flare of disease occurs, talk with your child’s health care provider about your child’s treatment options. Changing the dose, adding a new treatment to your child’s current treatment plan, or switching to a different treatment may help to decrease the pain and fatigue associated with psoriatic arthritis. Other tips include:

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Exercise

Make exercise fun. Encourage your child to be active by swimming, joining a sports team, or doing other activities they enjoy. The goal is to keep moving the joints to maintain muscle and joint function to avoid stiffness. If a physical therapist worked with your child previously, continue to do the stretching and muscle strengthening exercises but do them together. Always talk with your child’s health care provider before your child starts a new sport or exercise plan.

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Nutrition

Choose healthy, well-balanced foods for meals and snacks. Offer plenty of fruits and vegetables and create fun snacks that appeal to your child. To learn more request a copy of the NPF Healthy Eating Guide.

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Emotional Impact

Encourage your child to be open about their feelings and symptoms with you so that you can help them find a solution. Having psoriasis and/or psoriatic arthritis can take an emotional toll and even lead to depression. Learn more about the signs and symptoms of the emotional impact. Help your child learn as much as they can about their disease and to recognize that flares of the disease can happen with stress or illness and it is not their fault.

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Sleep

Be sure your child has enough sleep to help avoid feeling tired and fatigued. Overall children ages 6-12 years need at least 9 to 12 hours of sleep and teens ages 13-18 years need 8 to 10 hours of sleep. [4] If your child’s sleep is often interrupted by pain or movement, talk with their health care provider about how to improve your child’s sleep habits. Learn more about healthy sleep habits with the NPF Healthy Sleep Guide.

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School

Work with your child’s teacher and other school staff to ensure your child is able to participate in all activities at school or to identify where help may be needed. It is possible a 504 Plan may need to be implemented if accommodations need to be made on behalf of your child. Find school resources.

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Support

Talk with other parents who have a child with psoriatic arthritis and learn what they do to help their child live easier with psoriatic arthritis. You can find another parent through the NPF One to One Program.

New discoveries continue to be made that lead to a better understanding of why psoriatic arthritis occurs, new treatment options for treating psoriatic arthritis in children, and hope for living the best life possible with psoriatic arthritis. Continue to learn more about psoriatic arthritis.

Resources

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Patient Navigation Center

Contact the Patient Navigation Center to receive additional information about treatment options or if you need help adding a rheumatologist to your child’s health care team.

Get in touch
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Connect with Other Parents

Connect with a parent whose child has psoriatic arthritis and understands what it takes to live with the disease.

Connect today
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Podcast: The Future Looks Bright: Managing Psoriasis and PsA in Youth

Hear pediatric dermatologist Dr. Lara Wine Lee and pediatric rheumatologist Dr. Pam Weiss discuss the latest treatments, challenges, and research toward understanding psoriatic disease.

Listen now

References

1. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. Jan. 2020;82(1):161-201.

2. “What’s Juvenile Spondyloarthritis or JSpA?” podcast, National Psoriasis Foundation. 2022. Rheumatologist Dr. Hema Srinivasalu (Children’s National Hospital, Washington, D.C.), and patient advocates Wendy Olsder, Asad Khan, and Aamena Hameed. 

3. “PsA in Kids and Teens”  Advance Online. April 2021. Samantha Koons, Associate Director of Scientific Communications, National Psoriasis Foundation. https://www.psoriasis.org/advance/psa-in-kids-and-teens/

4. “Recommended Amount of Sleep for Pediatric Populations: A Consensus State of the American Academy of Sleep Medicine” https://aasm.org/resources/pdf/pediatricsleepdurationconsensus.pdf

 

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