Date: Monday, November 9, 2015
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To assess the demographic, clinical, and radiographic manifestations, health questionnaire (HQ) scores (physician global assessment, Health-related Quality of Life, parent/subject overall well-being and parent/subject pain), family history and drug regimens at enrollment and after one year follow up (F/U), in children with juvenile psoriatic arthritis (JPsA) in an international registry.
Methods: The study population included all JPsA patients in the registry between May 2010 – December 2013. We analyzed cross-sectional data at enrollment visit, stratified according to the age at disease onset (< or ≥ 6 years) and compared with information at 1 year F/U. Chi square or Fisher’s exact tests were used for categorical characteristics, t-tests for continuous variables, and Mann-Whitney-U tests for non-normally distributed variables. Comparison of binary variables between enrollment and F/U was performed using McNemar Test, and Wilcoxon Signed Rank Test for continuous variables. A multivariable logistic regression model was used to assess the influence of 1 year of treatment with DMARDs, biological DMARDs, NSAIDS or glucocorticoids (GCs) on objective outcome (improvement in ≥ 5 from the following: arthritis, dactylitis, enthesitis, skin psoriasis, sacroiliitis and nail pitting), and on subjective outcome (improvement in all 4 HQ scores) adjusted for age, gender, race and ethnicity.
Results: 361 children with JPsA were entered in the registry. The majority (93.9%) were white and not Hispanic (91.7%); 68.14% had symptom onset ≥ 6 years. Comparison between data in the two age groups at disease onset is presented in Table 1. Data after 1 year F/U were available for 222 patients. Statistically significant improvements were noted in the number of patients with ≥ 5 joints involved, nail pitting, dactylitis, psoriasis, enthesitis, sacroiliitis and uveitis [(126 (61.8%) vs 21 (10.2%,), (70 (35.9%) vs 31 (15%), (60 (30.9%) vs 5 (2.4%), (137 (68.2%) vs 73 (34.8%), (57 (29.5%) vs 17 (8.1%), (35 (18.1%) vs 13 (6.2%) (27 (15.1%) vs 8 (4.3%) P<0.0001 respectively]. Improvement in objective outcome was associated with disease onset < 6 years (OR 3.69, 95% CI 1.3-10.48), female gender (OR 2.44, 95% CI 1.07-5.56) and lack of biological DMARD (bDMARDS) therapy (OR 2.73 95% CI 1.16-6.44). Improvement in subjective outcome was associated with the presence of enthesitis (OR 4.14, 95% CI 1.12-15.25).
Conclusion: JPsA onset at or after age 6 is diagnosed earlier after symptom onset, with a male predominance and higher prevalence of psoriasis, nail pitting, enthesitis, sacroiliitis and less uveitis. This group is treated more often with daily NSAIDS and MTX and less often with intraarticular GCs. Females with disease onset before age 6 and not receiving bDMARDs have a better objective outcome, while patients with enthesitis had a better subjective outcome.
Table 1: Comparison between JPsA onset before and after the age of 6
N-actual number of patients
To cite this abstract in AMA style:Zisman D, Stoll ML, Gladman DD, Strand V, Lavi I, Hsu J, Mellins ED. Juvenile Psoriatic Arthritis Manifestations in a Cohort of 361 Patients from US and Canada [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/juvenile-psoriatic-arthritis-manifestations-in-a-cohort-of-361-patients-from-us-and-canada/. Accessed December 4, 2021.
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