Pediatric Psoriatic Arthritis: Diagnosis, Treatment, and Prognosis

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used first to treat joint inflammation symptoms. Methotrexate (Trexall) — a disease-modifying anti-rheumatic drug (DMARD) — might be used in younger children with childhood arthritis, but Imundo notes that there are new treatments now approved for children. And certain manifestations, such as sacroiliitis or enthesitis, would be treated with biologic medications.

Biologic drugs include tumor necrosis factor (TNF) inhibitors. TNF inhibitors used for pediatric PsA include infliximab (Remicade), adalimumab (Humira), etanercept (Enbrel), and golimumab (Simponi). Other approved agents now being used — especially if the psoriasis is severe — include secukinumab (Cosentyx) and ustekinumab (Stelara).

In 2023, the U.S. Food and Drug Administration (FDA) expanded the approval of abatacept (Orencia), a DMARD, to treat psoriatic arthritis in children over 2 years old.

“Children seem to tolerate the psoriatic arthritis medicines well,” says Imundo. “In a small percentage of patients, the TNF inhibitor adalimumab may trigger psoriasis, so we constantly monitor our young patients.”

In addition to medication, Imundo also recommends physical therapy, which is vital for range of motion. “Equally important are low-impact activities, such as swimming, biking, and low-impact aerobics,” she adds. “I urge teens to spend more time doing yoga and less time weight lifting.” Generally, however, she doesn’t restrict her patients and encourages them to choose activities they enjoy.

Imundo points to evidence that omega-3 fatty acids in fish oil supplements can help reduce inflammation. She also monitors patients’ levels of vitamin D. “Lack of vitamin D can predispose the child to an autoimmune type of reaction,” she says. Although omega-3s and vitamin D can be helpful as part of a treatment plan, she adds, they’re not effective alone for severe arthritis.