74 ROMANIAN JOURNAL OF RHEUMATOLOGY – VOLUME XXV, NO. 2, 2016 ORIGINAL ARTICLES MANAGEMENT OF PSORIATIC ARTHRITIS IN CHILDREN Alina Murgu, Evelina Moraru, Constantin Ailioaie, Ileana Ioniuc, Monica Alexoae, Bogdan Stana Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania 2 nd Pediatrics Clinic, Sf. Maria Children Emergency Clinical Hospital, Iasi, Romania Abstract Psoriatic arthritis affects 15% of children with chronic rheumatic joint disease. Aim of the study. To evaluate articular prognosis in 9 children (6-16 years) diagnosed with psoriatic arthritis and treated with different therapeutic agents, related to the degree severity of the cutaneous involvement. Results. Sex ratio in the study group was girls/boys = 3/6. 1 st degree relatives with psoriasis were found in 5/9 cases. Poliarticular juvenile arthritis with multiple localizations (small distal hand and feet joints, radiocarpal, tibiotarsian joints) were found in 6 cases; the other 3 patients had extensive oligoarthritis (no identified HLA B27 association). None of the patients had ankyloses or severe functional motor deficiency. PASI score <10 was found in 4 children. Specific therapy consisted of methotrexate (2 patients) and association between methotrexate and etanercept (7 patients); All 9 children received local topical therapy. After 6-month treatment, the evaluation of patients who have received methotrexate associated with etanercept found ACR Pedi 30 response in 4 children and ACR Pedi 50 in 3 cases; PASI score was lower than 10 in 5 of these children. The 2 patients under metho- trexate monotherapy showed neither ACR Pedi 30 response, nor improvement of the cutaneous symptoms after 6 months of treatment, so etanercept was added to methotrexate. The 12-month evaluation showed ACR Pedi 30 response in all 9 children; ACR Pedi 50 response in 6 children; PASI < 10 in 7 children. Conclusions. Early introduction of etanercept in addition to methotrexate seems to improve the prognosis of psori- atic arthritis, as well as skin disease, aspects that clearly ensure optimization of the quality of life of these patients. Keywords: psoriatic arthritis, child, prognosis Correspondence address: Alina Murgu, MD, Gr. T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, Iasi, Romania Psoriasis is a chronic inflammatory disease that can affect persons of any age, but most of the pa- tients are, at onset, adolescents and young adults. Its morbidity is directly related to the severity of the skin damage or systemic involvement, frequently as chronic arthropathy in 15-20% of cases, sometimes with disabling outcomes. At childhood age, the skin and joint symptoms can be found simultaneously or at a certain time interval, arthritis preceding by years the cutaneous manifestations. The objective of the study is to assess the course of articular involvement in children diagnosed with psoriatic arthritis under various treatment regimens and in relation to the severity of skin lesions. MATERIAL AND METHODS The study was conducted on a group of nine pa- tients (aged 6-16 years) diagnosed with psoriatic arthri- tis undergoing individualized treatment: methotrexate, etanercept and methotrexate, specific topical skin treat- ments. Evolution was assessed over one year, applying the ACR Pedi 30, ACR Pedi 50 response criteria for arthritis and PASI score for psoriasis. PASI score quantifies the percentual extension of the psoriatic skin lesions (1-4) characterized by: des- quamation, induration, erythema. Cutaneous affec- tion score below 10 defines the mild-moderate form and over 10 is specific for the severe form of the disease. The ACR Pedi 30/ACR Pedi 50 response is based on the following criteria assessing the severity of joint damage: number of swollen joints, reduced mo- bility and pain and/or tenderness (percentage im- provement (-) or worsening (+) compared to the score of the initial assessment); global assessment of severity by the physician (1-10); overall disease se- verity assessed by the patient (Visual Analogue Scale – VAS; score 1-10); CHAQ (Childhood Health As- sessment Questionnaire) [8 fields: dressing, eating, walking, daily hygiene and other daily activities etc.; 0-3]; ESR (mm/H) and CRP (quantitative). A 30%/50% improvement since baseline for 3 out of the 6 criteria for patients under therapy defines the ACR Pedi 30 and ACR Pedi 50 response, respec- tively.