Abstract
Juvenile Idiopathic Arthritis (JIA) represents the most common chronic rheumatologic disorder in children, encompassing a group of heterogeneous conditions with varied clinical manifestations. Juvenile Psoriatic Arthritis (JPsA) is a distinct subtype characterised by the association of arthritis with psoriasis or its related features. JPsA, a heterogeneous subtype of JIA, accounts for approximately 5% of all JIA cases, with reported ranges between 1% and 10%. An eight-year-old girl presented with subacute oligoarthritis involving bilateral hips and the right knee, along with nail pitting and minimal psoriatic skin changes, leading to a diagnosis of JPsA based on the International League of Associations for Rheumatology (ILAR) criteria. An incidental horseshoe kidney, a congenital renal anomaly with an incidence of approximately 0.2-0.25% in the general population and no established association with JPsA, was identified during evaluation. The child responded well to Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and methotrexate. The present case is notable for the rare co-existence of JPsA and an incidental horseshoe kidney, with no previously established association between the two conditions. It also underscores the importance of identifying congenital renal anomalies when planning long-term immunosuppressive therapy. Although incidental, identification of such renal anomalies is clinically relevant when planning long-term anti-inflammatory and immunosuppressive therapy.