Inflammatory arthritis in pediatric patients with morphea

Publication date: Available online 10 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Sakeen W. Kashem, Colleen K. Correll, Richard K. Vehe, Patricia M. Hobday, Bryce A. Binstadt, Sheilagh M. Maguiness
BackgroundMorphea, or 'localized scleroderma', is an inflammatory disorder resulting in fibrosis of the skin and subcutaneous tissues. Joint contractures, arthralgias and functional compromise are recognized associations of pediatric morphea. The co-existence of inflammatory arthritis and morphea is not well-described in the literature.ObjectiveTo investigate the relationship between pediatric morphea and inflammatory arthritis with regards to cutaneous, musculoskeletal and laboratory findings and treatment regimens.MethodsA systematic retrospective chart review of 53 patients with pediatric morphea was performed and analyzed for morphea subtypes, arthritic joint involvement, serum autoantibodies and therapeutic interventions.ResultsEleven out of 53 patients had polyarthritis that involved joints unrelated to the site of the cutaneous morphea. They were mostly female and presented with either the linear or generalized subtypes of morphea. Serum levels of antinuclear antibodies were more significantly elevated in patients with arthritis. All children were treated with methotrexate in addition to other systemic and/or topical immunosuppressive agents.LimitationThis was a small, single center, retrospective study.ConclusionPediatric morphea co-existed with inflammatory arthritis in 11/53 children. Further understanding and appreciation of this relationship may direct more intensive therapy and musculoskeletal screening

Teaser

Pediatric morphea is associated with joint contractures and arthralgia. The findings of this study support the association of inflammatory arthritis with pediatric morphea. Understanding of the relationship between morphea and arthritis in children should lead to increased musculoskeletal vigilance and appropriate systemic therapy.