Children with Psoriasis, Psoriatic Arthritis Experience Heightened Mood Issues

Children and young people with psoriasis at juvenile psoriatic arthritis (JPsA) diagnosis reported worse mood, implying a greater disease impact in patients with both joint and skin involvement, according to a study published in Rheumatology.¹ Investigators believe a multidisciplinary approach with an additional focus on supporting the wellbeing of this patient population may improve outcomes.

Jie Man Low, MBChB

Credit: ResearchGate

The International League of Associations for Rheumatology (ILAR) categorizes juvenile idiopathic arthritis (JIA) into homogenous subgroups to help with treatment and management strategies. However, prior research indicated categories like JPsA, a rare and under-research subset of JIA, may better represent more diverse entities. Half of patients with JPsA do not experience psoriasis symptoms, and therefore, their disease is distinct from other subtypes. Despite this, patients without psoriasis are usually grouped together with patients with psoriasis for research purposes.² By doing this, research has made the assumption, perhaps incorrectly, that all patients with JPsA have similar outcomes.

“In terms of clinical outcome, current literature has shown that the prognosis for JPsA is approximately similar when compared to other JIA subtypes,” wrote Jie Man Low, MBChB, Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, UK, and colleagues. “However, the presence of psoriasis is known to be associated with poorer physical health and higher cumulative active joint count, compared with other JIA subtypes. Furthermore, there are inherent limitations in assessing disease outcome when multiple aspects of disease are combined into single outcome measures, as these composite measures may mask the effects of JPsA on specific features of clinical outcomes.”

Children and young people who participated in the Childhood Arthritis Prospective Study (CAPS), a multicenter JIA inception cohort in the UK, between January 2001 and March 2018, were enrolled in the study. Parent- and patient-reported outcomes at diagnosis included pain (10 cm visual analog scale [VAS]), functional ability (Childhood Health Assessment Questionnaire [CHAQ]), the parental global assessment (10 cm VAS for wellbeing), health-related quality of life, parent psychosocial health, and mood/depressive symptoms (Mood and Feelings Questionnaire [MFQ]).

Additionally, 3-year outcome trajectories, based on data extracted at diagnosis, 6 months, and annually through 3 years, were defined using physician and parent global assessments (PGA and PaGA, respectively), as well as active joint counts. These patient-reported outcomes and outcome trajectories were compared in patients with JPsA vs other JIA categories, and patients with JPsA with and without psoriasis.

A total of 1653 patients with JIA were included in the study, of which 6.7% (n = 111) had JPsA at diagnosis. Within the whole cohort, most were White (76%) and female (64.7%), with a median age of 7.6 years at first pediatric rheumatologist visit. Among patients with JPsA, 55.9% were female with a median age of 10.9 years. Patients with concomitant psoriasis were older (12.7 years) compared with those without psoriasis (8.3 years).

No significant differences in patient-reported outcomes at diagnosis were observed between patients with or without JPsA. Among those with JPsA, patients with concomitant psoriasis at diagnosis exhibited more depressive symptoms (coefficient = 9.8, 95% confidence interval [CI] = .5 – 19.0) when compared with those without psoriasis.

Regarding the disease outcome trajectory, patients with psoriasis in JPsA were more likely to have persistently raised wellbeing scores when compared with other ILAR categories, even with improved PGA and joint counts (95% CI 1.2, 4.6).

“The better understanding of the impact of psoriasis on depressive symptoms and persistent poor wellbeing should encourage the need for clinical evaluation of the emotional state of children and young people with JPsA,” investigators concluded. “Whilst diagnosing and treating the condition early remains important, this study highlights the need for multidisciplinary management of JPsA.”

References

1. ^{Low JM, Hyrich KL, Ciurtin C, McErlane F, Wedderburn LR; CAPS Principal Investigators . The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis [published online ahead of print, 2023 Jul 19]. Rheumatology (Oxford). 2023;kead370. doi:10.1093/rheumatology/kead370}
2. ^{Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, Manners P, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 1998;25(10):1991-4}