Psoriatic Arthritis: Awareness and Approach

‘What do you mean? Kids don’t get arthritis–’ I remember a mother saying, as she recounted another parents’ comments during a school parent council meeting after her daughter was first diagnosed with Psoriatic Arthritis (PsA). Arthritis exists among children and adolescents. In fact, its prevalence has been increasing over the past few years.

I am a fourth-year medical student based out of Toronto, Ontario. Rheumatology has been among the specialties I had the opportunity to rotate in. The impact rheumatologic conditions can have on peoples’ quality of life and lived experiences is immense. One of my earliest experiences with rheumatologic conditions is an experience that continues to resonate with me was – when a young patient with several comorbid diseases, including arthritis and migraines, came to the ED requesting MAID (medical assistance in dying) due to her poor quality of life, as a result of her unmanaged comorbid conditions. 

This does not seem to be an anomaly (https://www.dyingwithdignity.ca/blog/maid-and-the-black-hole-of-chronic-pain/). More recently, someone in clinic with lupus arthritis described the experience as “[being] a shadow of [what I was] before… [I] use Tylenol… [and it] lasts 5-10min… just to [be able to] catch my breath.” Interacting with these patients illustrated how arthritis can deeply affect an individual and impact their physical, emotional, and psychological health. 

Spondylitis, or arthritis in the spine, is a possible manifestation of Psoriatic Arthritis (PsA). Unlike the name may suggest, patients with PsA can suffer from joint arthritis or plaque psoriasis alone, or simultaneously. When PsA presents in adolescents and children, it is said to be a form of Juvenile Idiopathic Arthritis (JIA). 

The illustration linked below, by Sir William Beechey illustrates one presentation of JIA, and dates back to 1793. This piece stands out as it is one of the earliest visual representations of JIA. Conditions such as JIA are pervasive and date back hundreds of years, however, the lack of awareness surrounding them continues to prevail. This can translate to the experience of JIA, such as PsA, to become an even more alienating experience. So, what makes the difference?

Recognizing symptoms associated with these diseases early, having a supportive medical team, and timely access to information and community of support, such as this forum, makes that difference. 

Since starting on my rheumatology rotation, I have come to learn of various resources that people living with arthritis can access, and I would like to highlight them here:

1. Connecting with others 

   1. Summer Camps

2. https://arthritis.ca/support-education/support-resources/support-for-childhood-arthritis/camps

3. To learn more about the condition, tests, treatment, and factors related to living with arthritis (e.g. sleeping & arthritis)

   1. https://rheuminfo.com 

4. Written for patients, by patients

   1. https://arthritispatient.ca/en/medications-to-treat-inflammatory-arthritis/ 

References:

https://mydailyartdisplay.uk/2012/02/19/portrait-of-sir-francis-fords-children-giving-a-coin-to-a-beggar-boy-by-sir-william-beechey/