Abstract
The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.
Highlights
Nail psoriasis is one of clinical manifestations of psoriasis (Ps); it is a typical, disfiguring picture of local changes and is associated with pain and functional disorders
102 people aged 30–64 years participated in the study, including 72 patients with nail psoriasis (41 with psoriasis without arthritis and 31 with psoriatic arthritis) and 30 people in the control group
Greater intensity of dermal changes compared to psoriatic arthritis (PsA) patients was observed in patients with psoriasis, whereas significantly higher inflammation parameters were observed in patients with arthritis
Summary
Nail psoriasis is one of clinical manifestations of psoriasis (Ps); it is a typical, disfiguring picture of local changes and is associated with pain and functional disorders. Involvement of nails is one of the known risk factors for the development of psoriatic arthritis (PsA)[1], which especially affects distal interphalangeal joints (DIP)[2]. 10–55% of patients with psoriasis, but the risk of the occurrence of such changes during a patient’s lifetime may be as high as 80–90%3. Inflammation associated with nail psoriasis may spread to adjacent structures, including DIP joints and digital extensor tendons[4]. An assessment of psoriatic changes in nails is practically based on clinical assessment indices, such as nail psoriasis severity index (NAPSI) and modified NAPSI (mNAPSI)[7,8]. Being a non-invasive and a relatively cheap method, US seems to be promising for use in assessment of progression of changes in nails and adjacent structure as well as treatment outcome. An early diagnosis of psoriatic arthritis or enthesopathies may significantly affect the therapeutic decisions and prognosis
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