Question:
A 10-year-old child presents with arthritis involving the wrist and first MCP joint. Examination shows nail pitting. Which of the following is the most likely diagnosis?
A 10-year-old child presents with arthritis involving the wrist and first MCP joint. Examination shows nail pitting. Which of the following is the most likely diagnosis?
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In the ILAR criteria for Juvenile Psoriatic Arthritis, if overt skin lesions are absent, remember the minor criteria: Dactylitis, Nail pitting ($>2$ pits), and Psoriasis in a 1st-degree relative (need at least 2 of 3).
Updated On: Sep 3, 2026
- Systemic sclerosis
- Psoriatic arthritis
- Systemic lupus erythematosus
- Mixed connective tissue disease
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The Correct Option is B
Solution and Explanation
Concept:
Juvenile psoriatic arthritis (PsA) is a distinct subtype of Juvenile Idiopathic Arthritis (JIA) characterized by the co-occurrence of arthritis and psoriasis or characteristic psoriasis-related clinical features.
According to the International League of Associations for Rheumatology (ILAR) classification criteria, definitive skin psoriasis is not strictly required if other diagnostic features such as nail pitting or dactylitis are present alongside arthritis.
Explanation:
• Juvenile psoriatic arthritis typically presents in a bimodal age distribution: an early peak in preschool-aged females (often presenting as oligoarthritis) and a late childhood peak in males and females.
• The ILAR criteria define juvenile psoriatic arthritis as arthritis with either:
1. Definite psoriasis, OR
2. At least two of the following: dactylitis ("sausage digit"), nail pitting ($>2$ pits) or onycholysis, and a family history of psoriasis in a first-degree relative.
• Nail changes, particularly punctate nail pitting, are strongly associated with distal interphalangeal (DIP) and MCP joint arthritis in psoriatic disease.
• Systemic sclerosis causes sclerodactyly and Raynaud phenomenon rather than isolated pitting with oligoarthritis/polyarthritis.
• Systemic lupus erythematosus causes non-deforming, non-erosive (Jaccoud-type) arthritis accompanied by multiorgan involvement and malar rash, not isolated nail pitting.
Final Answer:
The combination of arthritis in peripheral joints along with characteristic nail pitting is diagnostic of juvenile psoriatic arthritis.
Juvenile psoriatic arthritis (PsA) is a distinct subtype of Juvenile Idiopathic Arthritis (JIA) characterized by the co-occurrence of arthritis and psoriasis or characteristic psoriasis-related clinical features.
According to the International League of Associations for Rheumatology (ILAR) classification criteria, definitive skin psoriasis is not strictly required if other diagnostic features such as nail pitting or dactylitis are present alongside arthritis.
Explanation:
• Juvenile psoriatic arthritis typically presents in a bimodal age distribution: an early peak in preschool-aged females (often presenting as oligoarthritis) and a late childhood peak in males and females.
• The ILAR criteria define juvenile psoriatic arthritis as arthritis with either:
1. Definite psoriasis, OR
2. At least two of the following: dactylitis ("sausage digit"), nail pitting ($>2$ pits) or onycholysis, and a family history of psoriasis in a first-degree relative.
• Nail changes, particularly punctate nail pitting, are strongly associated with distal interphalangeal (DIP) and MCP joint arthritis in psoriatic disease.
• Systemic sclerosis causes sclerodactyly and Raynaud phenomenon rather than isolated pitting with oligoarthritis/polyarthritis.
• Systemic lupus erythematosus causes non-deforming, non-erosive (Jaccoud-type) arthritis accompanied by multiorgan involvement and malar rash, not isolated nail pitting.
Final Answer:
The combination of arthritis in peripheral joints along with characteristic nail pitting is diagnostic of juvenile psoriatic arthritis.
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