[Psoriasis und Psoriasis arthritis in childhood and adolescence. Overview and consensus statement of the 9th Wörlitz Expert Round Table Discussion 2006 for the Society for Child and Adolescent Rheumatology]

Abstract

There are about 1.2-1.6 million psoriasis sufferers in Germany. In about a third of these, the disease manifests before the age of 20. A classic complication of psoriasis is psoriasis arthritis (PsA), which, from the latest figures, effects about 20% of all psoriasis patients. PsA also starts in childhood and is included under the term juvenile idiopathic arthritis (JIA). The expert round table discussion which took place in 2006 in Wörlitz elaborated the recommendations for the classification, comprehensive diagnostics and therapy of effected children and adolescents. As controlled studies are lacking, the treatment of PsA has been empirically based and carried out in analogy with the treatment of other forms of JIA. The use of methotrexate (MTX) shows a good success rate. In 2004, about a third of the patients found in the core documentation, including over 80% of children and adolescents undergoing a primary therapy, were treated with MTX, a quarter in combination with other medication. A total of 7% of all and 16% of those undergoing primary therapy were treated with etanercept, most (>80%) in combination with basis medication, usually MTX. Consensus opinion indicated that an early, and intensive local skin therapy should be applied in order to reduce inflammatory activity. If PsA is present, the early use of non-steroid anti-inflammatories as well as local therapy of the joints with the intra-articular application of glucocorticosteroids is recommended. The primary medication should preferentially be MTX, if necessary combined with other therapies. In cases of a severe, episodic progression as well as high inflammatory activity, systemic glucocorticosteroids should be considered. Further studies addressing both the clinical course of jPsA compared to the adult manifestation as well as optimal therapeutic procedures should be initiated in the near future.