THU0546 Children with psoriasis also show enthesopathy signs related to skin disease activity
Authors: T.C. Meneghetti, T.M. Padilha, V.F. Azevedo, V.O. Carvalho
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Many recent evidences shows the role of enthesopathy in psoriatic disease and the high prevalence of musculoskeletal widespread pain in patients with psoriasis and psoriatic arthritis. It may be very difficult to distinguish between inflammatory disease activity and fibromyalgia. Limited data are available about the prevalence of rheumatological findings in children with psoriasis. <h3>Objectives</h3> To determine the prevalence of musculoskeletal pain complaints, enthesitis and tender points in a population of children and adolescents with psoriasis and correlate it to the skin disease activity and quality of life. <h3>Methods</h3> 26 children and adolescents with psoriasis were included in this cross sectional study and assigned a written informed consent. Patients and parents were interviewed about musculoskeletal complaints, personal and familiar history of rheumatic diseases. A paediatric rheumatologist performed the physical examination, which included evaluation of active joint count, palpation of entheses and tender points of fibromyalgia. A paediatric dermatologist performed PASI score and BSA to assess skin disease activity. Nails involvement where assessed by NAPSI. The functional capacity was assessed by CHAQ. The quality of life was assessed by CDLQI. <h3>Results</h3> Participants were 69% female, with a mean age of 10.1±3.0 years at observation. The median of age at the beginning of skin disease was 3 (0.5–12) years. PASI median was 4 (0.6–30.2), BSA 6 (2–39) and NAPSI 12.<sup>3–36</sup> A severe PASI above 5 were present in 38.5%. Complaints of any kind of musculoskeletal recurrent pain were seen in 46.1% of the patients and lumbar pain in 15.4%. Pain, limit on motion or joint oedema were seen in 26.9% whereas tenderness on palpation of any site of enthesis was found in 30.7% and tenderness on palpation of sacroiliac joint was found in 19,2% of the patients. The median of fibromyalgia tender points was 5 (0–16). The presence of enthesitis was associated to the skin disease activity scores of PASI (p&lt;0.006), BSA (p&lt;0.016) and nail index NAPSI (p&lt;0.05) (figure 1). As expected, the presence of enthesitis was associated to the number of tender points (p&lt;0.001). For those with a severe PASI&gt;5, we found a higher number of tender points (Med 0 versus 10; p&lt;0.03), a worst functional capacity by CHAQ (Med 0 versus 0.12; p&lt;0.03) and worst quality of life by CDLQI (Med 1 versus 9; p&lt;0.05). <h3>Conclusions</h3> High prevalence of musculoskeletal pain symptoms, enthesitis and fibromyalgia tender points was observed in this sample of children and adolescents with psoriasis. Differently from adults, we do not expect to have age-related degeneratives changes in entheses in this population, what reinforce the inflammatory origin of these rheumatologic findings. Otherwise, the association with the severity of psoriasis increases the need for vigilance against the appearance of psoriatic spondyloarthropathy in this group. <h3>Reference</h3> [1] Marchesoni A, De Marco G, Merashli M, McKenna F, Tinazzi I, Marzo-Ortega H, McGonagle DG. The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia. Rheumatology (Oxford). 2018Jan 1;57(1):32–40. <h3>Disclosure of Interest</h3> None declared