Department of Child Health, Faculty of Medicine
Universitas Padjadjaran, Dr Hasan Sadikin General Hospital, Bandung, West Java, 40162, Indonesia
Background: Psoriasis juvenile idiopathic arthritis (PsJIA) is an autoimmune disease, which constitutes a small part of Juvenile Idiopathic Arthritis (JIA) and classified within the spectrum of JIA and psoriatic lesion. The onset often occurs between the ages 7-13 years, but some of them occurs under 5 years. Its morbidity, such as: leg discrepancy, irreversible joint damage, contracture, visual loss caused by chronic uveitis, and persistent pain can impact the life quality of the patient. It is important to make an early and precise diagnosis, and give the treatment as soon as possible in order to make the quality of life of the patient optimum.
Methods: A six months longitudinal case report about a 3-year-old-boy with early onset psoriasis JIA and the result of the treatment.
Results: A 3-year-old-boy presented with a year history of right knee swelling accompanied by inflamation sign, joint stiffness, dactylitis, skin redness, and also white scales that generalized over his body. At first he was diagnosed with Ichtyosis vulgaris, because of the persistent arthritis (>6 weeks), he was referred from Dermatology and Venereology Department to Pediatric Immunology-Allergy Department with the highly suspected of JIA. He was born at term, from P1A0mother by spontaneous vaginal delivery, with a birth weight 3400 grams. There is no history of JIA or psoriasis in his family. From the laboratory examination, there were anaemia, with a small increased of the erythrocyte sedimentation rate (ESR), but C-reactive protein (CRP), liver and kidney function were within normal limits. Antinuclear antibodies (ANA), rheumatoid factor (RF) and anti-ds-DNA were negative. Before the treatment, the patient looked stiff, could not stand up well and could not move his hands, fingers and feet. The fingers bent like claws. After 5 months therapy of methotrexate, NSAIDs, physiotherapy and also topical momethasone furoate 0,1%, he experienced laboratory and clinically remission of arthritis and psoriasis.
Conclusions: The goals of therapy are to control pain and inflammation, prevent joint damage, preserve range of motion and muscle strength, strive for normal function, growth, nutrition, physical and psychosocial development and to control systemic manifestations. A multi-disciplinary team approach is essential in optimizing results. Physical and occupational therapy are important for some patients. Methotrexate (MTX) has been recognized as the most effective DMARDs and applicable in almost every countries. Genetic counseling and education about the disease is needed for every parents with affected child.