Young people with juvenile psoriatic arthritis who have psoriasis at diagnosis experience worse mood and greater depressive symptoms than their counterparts without psoriasis, UK researchers report.

The analysis found that children with psoriasis at diagnosis of psoriatic arthritis had more depressive symptoms (co-efficient 9.8. 95% CI=0.5 to 19.0) and scored 10 points higher on the Mood and Feelings Questionnaire (MFQ) on average than those without psoriasis (p=0.039).

The findings suggest that psoriatic arthritis has a greater impact on children and young people when the disease affects both skin and joints, the authors suggested in a paper published in Rheumatology.

“This increase in depressive symptoms in [juvenile psoriatic arthritis] patients with psoriasis could be related to the more severe disease picture seen in this subgroup of JPsA when compared to those without psoriasis, or the impact of visible signs of disease, namely fingernail abnormalities, which may be particularly distressing in school-aged young people,” they said.

The study also found that children and young people with juvenile psoriatic arthritis were 2.3 times more likely to report persistently high parent global assessments (PaGA) than other International League of Associations for Rheumatology (ILAR) subgroups, despite showing improving joint counts and Patient Global Assessment (PGA), the researchers noted.

“Multidisciplinary care with added focus to support wellbeing in children with [juvenile psoriatic arthritis] plus psoriasis may help improve these outcomes,” they suggested.

The study involved a total of 1,653 children and young people with juvenile idiopathic arthritis recruited from the Childhood Arthritis Prospective Study, of whom 111 (6.7%) were diagnosed with juvenile psoriatic arthritis, 65% were female, and 76% were Caucasian.

The data also revealed that juvenile psoriatic arthritis patients with psoriasis presented at median age of 12.7 years compared to those without who presented at median age of 8.3 years, but there was no significant difference in disease duration onset to first paediatric rheumatology appointment, at 5.1 months versus 5.9 months, respectively.

The researchers also noted that children and young people with juvenile psoriatic arthritis with psoriasis  “were more likely to be in a ‘remission’ than ‘low disease’ trajectory compared with those without psoriasis,” which “may suggest different types of joint disease or other extra-articular features in those with and without psoriasis, with correspondingly different disease courses, or different treatment strategies for those with psoriasis in juvenile psoriatic arthritis.

“Further study is required to explore how treatments can be tailored to PsA based on disease features and associated outcome,” they noted.

The data also showed no significant differences in patient-reported outcomes at diagnosis between patients with juvenile psoriatic arthritis and non-PsA, although there were significant differences when ILAR categories were separated and compared, according to the paper.

For example, children with polyarthritis “had higher odds of trajectories with greater active joints at diagnosis”, while children with persistent oligoarthritis “had consistently better outcomes” than those with juvenile psoriatic arthritis.

Key limitations of the research include uncertainty over whether children themselves or their carers completed the study questionnaires, and the potential for misclassification if psoriasis features occurred after diagnosis.

But the authors concluded that the findings “should encourage the need for clinical evaluation of the emotional state of children and young people with JPsA” and also “highlight the need for multidisciplinary management of JPsA”.