Lenka Turoňová, Martina Kostková, Peter Bánovčin
There is a convincing evidence that a subgroup of children with juvenile psoriatic arthritis (JPsA) is significantly clinically heterogeneous. The association of psoriasis with arthritis appears to lead to the identification of at least two (but probably more) different clinical phenotypes of JIA (juvenile idiopathic arthritis) patients. Of these, at least one large subcategory has, according to available literature, the same characteristics as the group of ANA (antinuclear antibody) positive children with an early JIA onset (prognostically less favorable group) that does not belong to juvenile spondyloarthropathies. Only a small fraction of JPSA patients exhibit features that belong to the spectrum of a relatively broad family of juvenile spondyloarthropathies, while this minority of patients may show some clinical resemblance to adult-type psoriatic arthritis. For this reason, the tendency of pediatric rheumatologists to clearly declare differences between JPsA and adult psoriatic arthritis is renewed as most patients differ significantly genotypically and phenotypically (and are treated differently) from the adult form. Because JPsA is not a homogeneous JIA subgroup, it is not treated as a single disease. A group of pediatric rheumatologists have been working on the reclassification of JPsA for a long time, but it remains unclear whether, as pediatricians, this term (quite confusing for adult rheumatologists) will be retained in future JIA subtype classifications, since it seems, that the presence of psoriasis itself (or psoriatic features) may rather be considered as so-called extraarticular phenotype disease descriptors. In this article, we focused our attention on the differences between juvenile and adult psoriatic arthritis forms, while we declare the clinical heterogeneity of JPsA subgroups in our own group of children with JPsA in the Žilina Region.