Background/Purpose:

Adult-onset psoriasis (PsO) and psoriatic arthritis (PsA) have been associated with increased rates of diabetes, obesity, and hypertension.  We sought to evaluate the prevalence of these comorbidities in children with PsO and juvenile PsA (JPsA) in the United States. 

Methods:

Utilizing a secure cloud-based platform, Explorys, we conducted a retrospective cross-sectional study of males and females ≤ 19 years of age from the United States with PsO and JPsA using pooled de-identified data from multiple United States healthcare systems, collected from 1999 to 2017. PsO subjects carried this diagnosis and also met exclusion criteria for any inflammatory arthritis or inflammatory bowel disease (IBD).  Patients with both IBD and JPsA were included and analyzed separately.  Comorbidities of interest included diabetes, hypertension, and obesity.  Hypertension and diabetes was determined by the presence of their respective Systematized Nomenclature for Medicine-Clinical Terms (SNOMED-CT), as the Explorys database is ontology based.   Subjects were considered obese if body mass index (BMI) was equal to or greater than the 95^th percentile, based on CDC 2010 recommendations.  Chi-squared test and odds ratio were calculated using Stata 10.0 software, Austin, Texas.   

Results:

Of those ≤19 years of age, 6180 subjects with PsO were identified and 930 were identified with JPsA, 50 of those were also diagnosed with IBD. Of the PsO subjects, 54% were male versus 34% of total JPsA.  Both cohorts were mostly Caucasian, with over three-fourths representation.  Among children with PsO, 42% were obese compared to 52% of JPsA children.  In this cohort, those with JPsA and IBD did not have concomitant diabetes or hypertension.  JPsA patients were significantly more likely to have diabetes, hypertension, and obese than patients with purely skin disease.  Having JPsA was associated with diabetes (OR 0.33, 0.23-0.48), hypertension (OR 0.41, 0.30-0.51), and obesity (OR 0.75, 0.65-0.86) compared to PsO.  Table 1 summarizes the findings of each patient population at the time of data collection. 

Conclusion:

Metabolic comorbidities are more prevalent in children with JPsA than PsO.  Hypertension and diabetes diagnosed in childhood is more common in those with JPsA compared to those with skin disease only.  Those diagnosed with PsO and JPsA in childhood have high rates of obesity, when determined by BMI percentile.