The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis

Abstract

Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.

Clinical and Social Aspects of Psoriatic Arthritis in Pediatrics

“…Для раннего дебюта заболевания характерно развитие олиго-или полиартрита с поражением мелких суставов и наличием антинуклеарных антител [6]. При появлении симптомов артрита в более позднем возрасте наблюдаются формирование энтезита, спондилоартрита, поражения аксиальных суставов, наличие антигена HLA-B27 [6][7][8].…”

“…было проведено исследование среди детей с псориазом в возрасте от 2 до 16 лет. Отмечена высокая частота болевого синдрома со стороны опорно-двигательного аппарата (персистирующая боль в проекции суставов, боль в поясничном и крестцово-подвздошном отделах позвоночника в покое и при пальпации), ассоциированного с тяжелым течением псориатического процесса на коже, поражением ногтевых пластинок и повышенной утомляемостью [7]. Авторы исследования отметили у пациентов с псориазом пониженный болевой порог.…”

“…Утомляемость как одна из ведущих жалоб была наиболее выражена среди пациентов с симптомами со стороны костно-мышечной системы. В отношении увеличения индекса NAPSI (Nail Psoriasis Severity Index), включающего оценку степени тяжести поражения матрикса ногтя и ногтевого ложа, отмечалась аналогичная тенденция [7]. Данное исследование демонстрирует возможность развития системного иммуновоспалительного процесса, предшествующего полноценной клинической картине ПсА.…”

Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis

“…However, musculoskeletal symptoms, including pain and fatigue, are highly prevalent in patients with PsO, having a negative impact on their physical function and quality of life [8]. These symptoms have been described not only in adults but also in children and adolescents with PsO [9]. In a more detailed way, Merola et al [8] reported an increased prevalence of musculoskeletal symptoms in a 60-month follow-up study of newly diagnosed adult patients with PsO (47.1% at baseline, 48.2% after 12 months, and 82.1% after 60 months).…”

<p>Optimal Management of Plaque Psoriasis in Adolescents: Current Perspectives</p>

“…a negative impact on the quality of life (QoL), all children and adolescents with psoriasis should be screened for arthritis. 28 A four-question evaluation of clinical history has been proposed to screen for arthritis in children with psoriasis (Box 1). Assessment of adolescents using the Psoriasis Epidemiology Screening Tool (PEST) has also been proposed, together with the referral of patients to a rheumatology department if any signs or symptoms of arthritis are reported.…”