Phenotype of Uveitis in Children With Psoriatic Arthritis or Psoriasis
American Journal of Ophthalmology, February 2018
Salek et al. pooled the experience of 2 university-based referral centers to begin characterizing the uveitis associated with juvenile psoriatic arthritis and psoriasis. Findings of their study suggest that early-onset juvenile psoriatic arthritis may be a distinct condition, one that is especially severe when it starts before the child is 7 years old.
Study data were collected from Oregon Health & Science University in Portland and the University of Bristol in England. Overall, 6 children were identified (4 boys, 2 girls). Of these, 5 had uveitis and psoriatic arthritis, and 1 had uveitis plus psoriasis. Medical records were reviewed for demographics, descriptions of ocular and joint diseases, medical treatments administered, and complications.
The mean age at presentation was 5.7 years (range, 2-12 years). In 5 of the 6 patients, the disease began before 6 years of age. The uveitis was bilateral in 4 patients. Three patients had anterior uveitis only, and 3 had combined anterior and intermediate uveitis. The response to topical corticosteroids was inadequate in all 6 children. Despite the use of systemic corticosteroids for many months in most of the children, all 6 eventually required methotrexate. Inadequate response to methotrexate resulted in treatment with 1 or more biologic agents in every patient. Five patients underwent at least 1 ophthalmic surgery (e.g., vitrectomy, cataract extraction, glaucoma control).
Although the sample size was small, results indicate that children with psoriasis or psoriatic arthritis occurring by age 6 are at risk for bilateral, chronic, severe uveitis that could warrant biologic therapy as well as surgery.
The differential diagnosis of arthritis associated with psoriasis is extensive. It includes ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, Behçet disease, Kawasaki disease, and sarcoidosis. The authors suggest that early-onset juvenile psoriatic arthritis be added to this list as an entity distinct from other types of psoriatic arthritis.
The original article can be found here.