title: Juvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis?
abstract: BACKGROUND
  Following the introduction of the ILAR criteria for juvenile idiopathic arthritis, juvenile psoriatic arthritis (JPsA) has become a better recognized category within the inflammatory arthritides of childhood. There are fewer reports describing the characteristics and long-term outcome of patients with JPsA than other subtypes of JIA.The aim of our study was to determine the long-term outcome and clinical course of patients with juvenile psoriatic arthritis (JPsA) and to define subgroups of JPsA.
  
  
  METHODS
  Clinical records of all patients meeting criteria for JPsA were reviewed and divided into 4 groups depending on their clinical features and onset type. Patient characteristics and clinical features at onset and during follow-up were determined.
  
  
  RESULTS
  The cohort consisted of 119 patients: 65 with oligoarticular-onset (55%; persistent 44 and extended 21), 34 (29%) with RF(-) and 4 (3%) RF(+) polyarticular and 16 (13%) enthesitis-related arthritis (ERA). At diagnosis patients with ERA were oldest and more commonly male (p=0.001 and =0.01 respectively). Patients with a polyarticular course had more involvement of small joints of the hands and wrist when compared to patients with persistent oligoarticular and ERA (p<0.001) while patients with ERA had more hip and sacroiliac arthritis (p<0.001 for both). Nail changes were seen in 66 patients (57%) and were associated with DIP involvement (p=0.0034).
  
  
  RESULTS
  Time to first inactive disease on, but not off, therapy was significantly longer among patients with polyarticular course when compared to oligoarticular and ERA (p=0.016 and p=0.48 respectively). Patients with polyarticular course more frequently had contractures during follow-up than other groups (p=0.01).
  
  
  CONCLUSIONS
  The long-term outcome of with JPsA was generally good. Patients with JPsA did not appear to form distinct sub-group of patients but rather resembled JIA patients with onset types without psoriasis.
authors.affiliation: Division of Rheumatology, SickKids Hospital, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada. earl.silverman@sickkids.ca.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Butbul Aviel
authors.forename: Pascal
authors.initials: P
authors.lastname: Tyrrell
authors.forename: Rayfel
authors.initials: R
authors.lastname: Schneider
authors.forename: Sandeep
authors.initials: S
authors.lastname: Dhillon
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
authors.forename: Ronald
authors.initials: R
authors.lastname: Laxer
authors.forename: Rotraud K
authors.initials: RK
authors.lastname: Saurenmann
authors.forename: Lynn
authors.initials: L
authors.lastname: Spiegel
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cameron
authors.forename: Shirley Ml
authors.initials: SM
authors.lastname: Tse
authors.forename: Earl
authors.initials: E
authors.lastname: Silverman