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Coronel L, Gouze H, Gudu T, Ruel-Gagné S, Padovano I, Costantino F, Vidal F, Breban M, Mahé E, D'Agostino MA. Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis. Rheumatology (Oxford) 2024; 63:1391-1396. [PMID: 37540167 DOI: 10.1093/rheumatology/kead398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence of clinical and US (grey-scale and Doppler) abnormalities in joints, periarticular structures and nails of children affected by skin psoriasis (PsO). METHODS We conducted a cross-sectional study including consecutive children affected by PsO. A systematic clinical and US evaluation of joints, entheses, tendons and nails were performed by independent examiners blinded to each other's assessment. RESULTS A total of 57 children [26 girls (46%)] with a mean age of 9 years (s.d. 4) were divided into two groups, asymptomatic (Asy, 42 children) and symptomatic (Sy, 15 children), according to musculoskeletal pain. Differences were observed between the two groups in relation to age [9 years (s.d. 3) vs 11 years (s.d. 4), P < 0.05], PsO duration [2.4 years (s.d. 2.4) vs 5.4 years (s.d. 3.9), P < 0.001], systemic treatment [23 (54.8%) vs 2 [13.3%], P < 0.01], tender joint count [0 vs 12 children (80%), P < 0.001], swollen joint count [0 vs 3 children (20%), P < 0.01] and entheseal pain [0 vs 10 (66.7%), P < 0.001] in Asy and Sy children, respectively. US evaluation showed statistically significant differences between the Asy and Sy groups for the presence of US abnormalities [16/42 (38%) vs 12/15 (80%)], synovitis [1/42 (2%) vs 4/15 (25%)] and enthesitis [4/42 (9.5%) vs 5/15 (33%)]. Three children in the Sy group were classified with juvenile PsA (JPsA). CONCLUSIONS US abnormalities were higher in the Sy group, with synovitis and enthesitis as the most prevalent findings. Asy patients were more frequently under systemic treatment. US and a systematic clinical evaluation are useful tools for detecting subclinical JPsA in children with PsO and musculoskeletal symptoms.
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Affiliation(s)
- Luis Coronel
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Rheumatology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hélène Gouze
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Inserm U1018, Center for Research in Epidemiology and Population Health "Integrative Respiratory Epidemiology" Team, Paris-Saclay University, Villejuif, France
| | - Tania Gudu
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Sophie Ruel-Gagné
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Ilaria Padovano
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Félicie Costantino
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
| | - François Vidal
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Maxime Breban
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
| | - Emmanuel Mahé
- Dermatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Maria-Antonietta D'Agostino
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
- Rheumatology Department, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Mahé E, Amy De La Bretêque M, Phan C. Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients. Expert Rev Clin Pharmacol 2021; 14:807-819. [PMID: 33784929 DOI: 10.1080/17512433.2021.1911641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Psoriasis affects about 0.5% of children and adolescents, it has a high impact of social life. Management can be difficult. The beginning of the 21st century has been an interesting period for the management of pediatric psoriasis, with access to new topical and systemic treatments including several biotherapies. AREAS COVERED Herein, we analyze the current therapeutic strategies for managing psoriasis in young patients, ranging from infants to adolescents, in a holistic approach. Usual treatment but also new galenics, new topical associations, and biological (anti-TNF-alpha, anti-interleukin 12/23, anti-interleukin 17) recently developed are presented. Results from clinical trials are detailed, but also real-world evaluations, and recent guidelines. Practical tips for day-to-day management are finally proposed. EXPERT OPINION Currently, we have a wide range of treatments, which we can adapt to all types of psoriasis, depending on the demands of the child and his parents. The near future also looks promising with new topical combinations, new oral therapies (apremilast) and biologics (anti-interleukin 23), as well as genetically targeted therapies for pustular psoriasis.
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Affiliation(s)
- Emmanuel Mahé
- Service De Dermatologie Et Médecine Vasculaire, Hôpital Victor Dupouy, Argenteuil, France
| | | | - Céline Phan
- Service De Dermatologie Et Médecine Vasculaire, Hôpital Victor Dupouy, Argenteuil, France
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Mahé E. Optimal Management of Plaque Psoriasis in Adolescents: Current Perspectives. PSORIASIS-TARGETS AND THERAPY 2020; 10:45-56. [PMID: 33274179 PMCID: PMC7708777 DOI: 10.2147/ptt.s222729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
The skin is at the interface between the body and its environment and is therefore at the center of adolescent concerns during this period of identity formation and increased awareness of body image issues, and stigmatization. Managing an adolescent with psoriasis involves managing the illness and the individual during their transition from being an older child to a young adult. In addition to ensuring that the patient adheres to treatments and is engaged with the therapeutic strategy, dermatologists may also need to manage issues linked to unspoken suffering or conflicts between the adolescent and their parents, who are often present during consultations. The impact of psoriasis on the social interactions, school life and sexuality of the patients, together with the influence of the internet and social networks, also have to be taken into account. In this review, we summarize the epidemiologic, clinical, and therapeutic data available on psoriasis in adolescents, and propose specific management strategies, adapted to the 21st century, for patients in this age group.
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Affiliation(s)
- Emmanuel Mahé
- Service De Dermatologie Et Médecine Vasculaire, Hôpital Victor Dupouy, Argenteuil 95100, France
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Kerkhof P. The Dermatologist and psoriatic arthritis. J Eur Acad Dermatol Venereol 2018; 32:1836-1837. [DOI: 10.1111/jdv.15216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P.C.M Kerkhof
- Radboud University Nijmegen Medical Centre Nijmegen The Netherlands
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