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Juvenile Psoriatic Arthritis: Symptoms in Children and Teens

Medically reviewed by Florentina Negoi, M.D.
Posted on January 5, 2024

Juvenile psoriatic arthritis (PsA) is a relatively rare form of childhood arthritis, accounting for about 5 percent of cases. Continue reading if you are a parent or caregiver of a child who has PsA. Here, we will discuss the symptoms of PsA, which can vary depending on your child’s age. We will also briefly cover the causes, treatment options, and likely prognosis (outcomes) for children with PsA.

General Symptoms of Psoriatic Arthritis

For any age, PsA is a condition that affects the joints and skin. Some common symptoms include:

  • Inflamed, dry, scaly patches of skin
  • Stiffness and joint pain
  • Feeling tired (fatigue)
  • Dactylitis (swollen fingers and toes)
  • Nail bed damage
  • Uveitis (eye inflammation)
  • Digestive issues (such as inflammatory bowel disease)

    Read this article for more information on early warning signs of PsA.

    What Is Juvenile Psoriatic Arthritis?

    The definition of juvenile PsA has changed over the years. Presently, a well-accepted classification comes from the International League of Associations of Rheumatology. According to their criteria, a child may be diagnosed with PsA when they have both arthritis and psoriasis or if they have arthritis and at least two of the following:

    • Dactylitis (swollen fingers and toes)
    • Nail pitting (tiny dents in finger or toenails)
    • Onycholysis (nail separating from the nail bed)
    • Family history of psoriasis

    A potential sign of psoriatic arthritis in a child or teen is swollen fingers or toes in addition to arthritis. (CC BY-NC-ND 3.0 NZ/DermNet)

    Arthritis and nail changes like pits, or horizontal grooves, in the finger or toenails can be signs of psoriatic arthritis in children and teens. (CC BY-NC-ND 3.0 NZ/DermNet)

    Onycholysis, the separation of nails from the nail bed, and arthritis are symptoms that may be used to make a psoriatic arthritis diagnosis. (CC BY-SA 4.0/Naddei et al.)

    Children with PsA may have very different symptoms, depending on the age of onset. In a review of juvenile PsA cases, a study found that there are two subgroups: those who develop symptoms in the first few years of life and those who develop symptoms in their early teen years.

    Early-Onset Juvenile Psoriatic Arthritis

    Toddlers with PsA, on average between the ages of 2 and 3 years old, are considered to have early-onset juvenile PsA. It’s more common for young girls to have early-onset PsA than young boys.

    Symptoms

    Early-onset juvenile PsA symptoms usually begin in multiple joints (also called “polyarticular onset”). Children with early-onset PsA, compared to those with older-onset PsA, typically have a higher incidence of:

    • Swollen fingers and toes
    • Positive test results for antinuclear antibodies, which are immune proteins that attack healthy cells

    Older-Onset Juvenile Psoriatic Arthritis

    When an adolescent, on average between the ages of 10 to 12 years old, is diagnosed with juvenile PsA, it’s known as older-onset juvenile PsA. Gender is less of a factor in older-onset PsA, although males may be affected a bit more, according to the journal Current Opinion in Rheumatology.

    Symptoms

    Symptoms of older-onset juvenile PsA are similar to another type of arthritis called spondyloarthritis and more closely resemble adult PsA, including:

    • Enthesitis (inflammation in the attachment of ligaments and tendons to bone)
    • Axial disease (conditions that affect the spine)
    • Positive test results for human leukocyte antigen B27 (HLA-B27), immune proteins that help the body’s immune system recognize its own cells versus something foreign

    Adult vs. Juvenile Psoriatic Arthritis

    In adults, arthritis typically presents itself six or seven years after one is diagnosed with psoriasis. However, in children, psoriatic skin symptoms usually develop 10 years after developing arthritis. The pattern of symptoms can make it hard for doctors to diagnose PsA in children and developing teens.

    In both adults and children with PsA, joint damage and spine involvement are common. Juvenile PsA typically has milder axial (spine) complications than adult PsA. Inflammation of the ligaments and tendons connecting to bones and swelling of the fingers and toes are also common across both age groups.

    Diagnosing Juvenile Psoriatic Arthritis

    Diagnosing a child with PsA early is important because delaying treatment could result in permanent joint damage. If a child has a family medical history of psoriasis and starts to have painful joints, it may be worth seeking a doctor and asking for a specialist.

    Typically, a pediatric rheumatologist (a doctor who specializes in arthritis in children) can diagnose a child with PsA. They may do a physical examination and order imaging tests like X-rays and MRI scans. These doctors may also do basic blood counts and tests that check for genetic inflammatory markers. If some of these genetic markers are positive, then the child may be at a higher risk of developing eye inflammation and axial disease. Blood tests that look for abnormal inflammation levels may include:

    • Erythrocyte sedimentation rate (ESR), which shows how quickly blood cells settle to the bottom of a test tube
    • C-reactive protein (CRP) levels, a protein made by the liver that increases with body inflammation
    • Plasma viscosity (PV), a marker of your blood’s thickness

    What Causes Juvenile Psoriatic Arthritis?

    PsA is an autoimmune disease, which means the immune system malfunctions and causes inflammation. According to a doctor from the National Psoriasis Foundation, “More than half of children with psoriatic arthritis have at least one family member affected by psoriasis.” This information leads researchers to believe genetics may play a role, in addition to other factors, in developing juvenile PsA.

    Common Treatments

    The American College of Rheumatology suggests the goal of treatment should be to manage symptoms, improve function, and protect the child’s developing joints. A variety of approaches may be used, such as:

    • Topical ointments to help relieve skin psoriasis
    • Anti-inflammatory drugs to help control inflammation and pain
    • Steroid injections and corticosteroids for short-term flare-ups
    • Disease-modifying antirheumatic drugs (DMARDs) that target specific pathways within the immune system
    • Biologics such as tumor necrosis factor (TNF) inhibitors
    • Physical therapy and occupational therapy

    In addition to protecting a child’s joints, a MyPsoriasisTeam member who had PsA as a child urged other parents to “be supportive and do everything you possibly can to build their self-esteem. I did not get that when I was young.”

    It’s also important to keep in mind that everyone’s circumstances are unique, and treatment should be tailored to each child. For example, a side effect of a common treatment for one symptom (such as an over-the-counter anti-inflammatory drug) could make another symptom worse (such as irritable bowel syndrome).

    New Treatment Options

    Some new treatments are emerging for children with PsA. For example, tofacitinib (Xeljanz), a synthetic DMARD already used in adults, has been recently approved for use in pediatric PsA cases.

    Will Your Child Grow Out of It?

    While there is no cure for PsA, with treatment, it’s possible to get symptoms under control and achieve remission. According to recommendations from the Arthritis Foundation, it’s important to continue treatment even after symptoms disappear to reduce the chance of flare-ups and prevent joint damage. It’s also important to protect a growing child’s joints for the best chance of positive long-term outcomes.

    PsA, unlike rheumatoid arthritis, does not seem to have a predictable pattern. Flare-ups can occur often, not at all, and for short or long periods.

    Prognosis

    If juvenile PsA is diagnosed early and treatment starts promptly, the prognosis for a child or teen with PsA is very good. However, even if juvenile PsA was diagnosed after a few years, the long-term prognosis is still good.

    Some lifestyle changes that could help with managing PsA symptoms include stress management, healthy eating, and proactively reducing joint inflammation. Alternative methods for reducing inflammation are acupuncture, using heat and cold, and exercising an adequate amount (not too little, but also not too much).

    For recommendations on exercise, read this article about preserving range of motion with PsA.

    Connect with Others Who Understand

    MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

    Are you a caregiver of a child or teen with juvenile psoriatic arthritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on January 5, 2024
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    Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here.
    Amanda Studnicki, Ph.D. earned her Bachelor of Science in biomedical engineering from the University of Delaware in 2014 and a doctorate of philosophy from the University of Florida in 2023. Learn more about her here.

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