For Parents – What is Psoriatic Arthritis?

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. It is possible to develop psoriatic arthritis and joint inflammation 2 to 3 years prior to having signs of psoriasis. [1] One in three adults living with psoriasis may also have psoriatic arthritis.

Symptoms

In 80% of children with psoriatic arthritis, joint inflammation develops before skin disease onset, usually 2 to 3 years in advance of skin involvement. [1] Symptoms of PsA can range from mild to very painful and vary from child to child. In addition to inflammation and swelling of joints, common symptoms may include warmth at the site of joints, stiffness primarily in the morning or after inactivity, psoriasis lesions, nail pitting, and difficulty in moving and completing daily tasks.

Children tend to have arthritis in joints such as the knee, elbow, ankle, wrist, jaw, and spine. While joint symptoms can occur at any age, there are two common age groups [1] when symptoms of psoriatic arthritis are more likely to occur:

Between 2 - 3 years old, which tends to be more common in girls and affecting smaller joints. Usually, a few joints can be affected with dactylitis, where an entire finger or toe may be swollen. This is also referred to as “sausage digit”. Younger children are also at risk for developing uveitis, a serious inflammatory eye disease that can cause pain, redness, and blurry vision. Your child’s health care provider can run an antinuclear antibodies (ANA) test. If it is positive that means the risk of developing related eye inflammation is high. [3] Your child should follow-up with an ophthalmologist.

Between 10-12 years old, where psoriatic arthritis tends to be more common in boys. Children in this age group tend to have enthesitis, which refers to swelling and inflammation of areas where muscles, tendons, and ligaments connect to bone. Examples are the back of the heel where the Achilles tendon inserts into bone or above the knee where the patellar tendon inserts. Other common areas include axial joint involvement (the spine), and the hip area where the sacroiliac joints link the pelvis and the lower spine. If a human leukocyte antigen (HLA-B27) test is positive, then the risk of developing arthritis in the lower back is higher. [3]

Terms you may hear in reference to your child’s psoriatic arthritis include:

Oligoarticular affecting 4 or fewer joints.
Polyarticular affecting 5 or more joints.

Flares of psoriatic arthritis can come and go, lasting for different periods of time and vary in severity. Keep track of what may trigger the flare for your child by using a fillable symptom tracker. Share this information with your child’s health care provider to help discuss symptoms and a treatment plan.

Keep in mind that children may not understand they are experiencing pain, especially at a young age. They could be slow to get up in the morning or have a slight limp unrelated to an injury. Watch for these and other subtle signs [2] to mention to your child’s health care provider.

It is important to diagnose early and treat psoriatic arthritis effectively to help avoid irreversible joint damage, disability, and reduced quality of life.

Diagnosis

There are several health conditions that can mimic or resemble symptoms of psoriatic arthritis. It is important to discuss symptoms with your child’s health care provider or ask for a referral to see a rheumatologist to ensure an appropriate diagnosis is made. If uveitis is present your child may also be referred to an ophthalmologist, a doctor who specializes in diagnosing and treating eye and vision conditions.

Rheumatologist

A rheumatologist is a doctor who specializes in the diagnosis and treatment of arthritis and musculoskeletal diseases that impact the joints, muscles, and bones. If your child experiences inflammation, pain, and fatigue in those areas, consider asking for a referral to a rheumatologist. You may also work with a Nurse Practitioner (NP) or Physician Assistant (PA) who specializes in rheumatology.

Currently, there is no single test to diagnose psoriatic arthritis. Your child’s health care provider will conduct a physical examination, run laboratory work, and possibly do imaging such as an x-ray or ultrasound to confirm the diagnosis. Considerations for a diagnosis of psoriatic arthritis include:

Does the child have psoriasis?
Are symptoms of arthritis present and for how long?
Is there a family history of psoriasis or psoriatic arthritis (either a first- or second-degree relative)?
Any swelling of whole fingers or toes rather than just knuckles (dactylitis)?
Is there inflammation where tendons or ligaments connect to bones (enthesitis)?
Does the child have nail pitting or separation from the nail bed (onycholysis)?
Is the child overweight for their age or has other health concerns?

Laboratory tests could include a complete blood count to test for anemia (low red blood cell counts) and platelet count, which can be elevated when inflammation is present. Anemia is often associated with chronic inflammatory arthritis. Other blood tests such as a C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are done to determine if inflammation is present. The CRP and ESR results are often elevated in children with psoriatic arthritis. A rheumatoid factor test may be done to rule out rheumatoid arthritis. A negative test means there are other reasons for the inflammation, like psoriatic arthritis.

Assessing all the above results will help a health care provider identify if psoriasis arthritis is present and what next steps, such as treatment, should be offered to help reduce symptoms. While there is no one test currently used to diagnose psoriatic arthritis, the National Psoriasis Foundation is actively funding research to identify biomarkers that one day will lead to a reliable diagnostic test.

If you need help finding a rheumatologist or other health care providers for your child’s health care team:

Contact the Patient Navigation Center
View our Health Care Provider Directory to find specialists in your area, including pediatric specialists.

You can find tips for preparing for your child’s health care provider visits and how to build communication between providers here.

How to Treat JPsA

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

Find JPsA treatment options

Resources

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Patient Navigation Center

Contact the Patient Navigation Center to receive the free booklet “Psoriatic Disease and Children: A Guide for Parents” for more information about psoriasis and psoriatic arthritis or if you need help adding a rheumatologist to your child’s health care team.

Get in touch

Webinar: Your Child and Psoriatic Arthritis

Pediatric rheumatologist Dr. Meredith Profeta Riebschleger addresses the signs, symptoms, diagnosis, and treatment of psoriatic arthritis in youth.

Watch now

Presentations of Psoriatic Arthritis

Learn more about the presentations of psoriatic arthritis including dactylitis, enthesitis, and spondylitis.

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

This program is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $351,404, with 2 percentage funded by CDC/HHS and $14.3 million amount and 98 percentage funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.