Nail Bed Thickness Research Articles

Ultrasound Assessment of Psoriatic Arthritis Patients With Clinically Normal Nails and Evaluation of its Correlation With the Disease Activity: A Case-Control Study.

Nail unit is one of the targets of ultrasound (US) assessment. We aimed to compare ultrasound parameters of clinically normal nail unit in psoriatic arthritis (PsA) patients with healthy controls (HC) and evaluate their correlations with disease activity. This was a cross-sectional study including patients with PsA and matched HC. Tender (TJC) and swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and Disease Activity in Psoriatic Arthritis (DAPSA) were collected in PsA patients. Patients underwent US assessment of fingernails with a study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT), and adjacent skin (ST). Correlation between nail unit parameters and disease activity was studied. We evaluated 22 PsA patients (219 nails) and 21 HC (210 nails). Mean DAPSA was 21.56 ± 14.36 and mean PASI was 2.19 ± 3.8. PsA patients had more US morphological changes than HC (16.89 vs 3.33%, P = .03). NPT comparison between identical fingernails of PsA and HC did not reveal significant difference. However, NBT was significantly higher in HC (1.77 vs 2.07 mm, P = .027) as well as ST (2.26 vs 2.59 mm, P = .003). TJC and ST were positively correlated (r = .46, P = .03). No correlation was noted between disease activity scores and NPT, NBT, or ST in PsA patients. In biologic parameters, ESR was negatively correlated with ST (r = -.41, P = .05). Nail bed and adjacent skin US morphological changes were contributive to distinguish psoriatic from healthy nails. Adjacent skin thicknessmeasurement was positively correlated with TJC and ESR, suggesting that it could be used as an indicator of disease activity in PsA.

Ultrasonographic and power doppler parameters of nails fail to differentiate between onychodystrophy in patients with psoriasis vulgaris or psoriatic arthritis

BackgroundNail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy.MethodsA cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler.ResultsA significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124).ConclusionGreater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can’t distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.

Ultrasonographic Evaluation of Nail Involvement in Patients With Axial Spondyloarthritis.

This study aimed to evaluate the nail units of patients with axial spondyloarthritis (ax-SpA) using ultrasound and to identify any subclinical changes. We also aimed to examine the relationship between clinical enthesitis scores and nail involvement in patients with ax-SpA. The study included 40 patients with ax-Spa, 40 patients with psoriatic arthritis (PsA), and 40 healthy controls. The thickness of the nail plates, morphological changes, the thickness of the proximal nail units, the thickness of the nail beds, and power Doppler signal intensities were evaluated and compared. Maastricht Ankylosing Spondylitis Enthesitis Score and Spondyloarthritis Research Consortium of Canada Enthesitis Index were also evaluated in patients with ax-SpA. There was no significant difference between the thickness of the nail plates of the three groups (P > .05). The first nail bed thickness of ax-SpA cases was significantly higher than the control group (P = .046), and the fourth and fifth nail proximal unit thicknesses of the control group were significantly lower than the ax-SpA and PsA groups (P = .023, P = .017). We also found that the Wortsman scores of the cases with PsA were significantly higher than the ax-SpA and control groups (P = .0001). The thickness of the proximal nail unit adjacent to the insertion of the digital extensor tendon, which is considered as the enthesis area, is similar to the patients with PsA in patients with ax-SpA, especially in the fourth and fifth fingers compared to the control group. On the other hand, almost no structural changes in nail plates were observed in patients with ax-SpA group.

Assessment and Monitoring of Nail Psoriasis with Ultra-High Frequency Ultrasound: Preliminary Results.

Psoriatic onychopathy is one of the clinical presentations of psoriasis and a well-known risk factor for the development of psoriatic arthritis. High-frequency ultrasounds (HFUS > 20 MHz) have recently been used to evaluate the nail apparatus of healthy and psoriatic subjects. The aim of our study was to detect by means of ultra-high-frequency ultrasound (UHFUS 70-100 MHz) alterations of the nail bed and matrix in patients with psoriatic onychopathy and to monitor these parameters during the treatment with monoclonal antibody (mAb). We enrolled 10 patients with psoriatic onychopathy and naive to previous biologic therapies. Patients were evaluated at baseline, after 1 month and after 3 months from the beginning of mAb therapy by a complete clinical assessment and US evaluation. A UHFUS examination with a 70 MHz probe was performed on the thumbnail (I), the index fingernail (II) and the nail with greater clinical impairment (W). The following measurements were analyzed: nail plate thickness (A), nail bed thickness (B), nail insertion length (C), nail matrix length (D) and nail matrix thickness (E). Among the various parameters analyzed, some measures showed a statistically significant decrease with p-value < 0.05 (t0 WA = 0.52 mm vs. t2 WA = 0.42 mm; t0 WB = 2.8 mm vs. t2 WB = 2.4 mm; t0 WE = 0.76 mm vs. t2 WE = 0.64 mm; t0 IIA = 0.49 mm vs. t2 IIA = 0.39 mm). In conclusion, UHFUS could represent a viable imaging technique for the real-time evaluation and monitoring of psoriatic onychopathy, thus supporting the clinical parameters and revealing any subclinical signs of early drug response.

AB0958 The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis: ultrasound study

BackgroundIt has been shown that there is an anatomical link between the distal interphalangeal joint (DIP) extensor tendon enthesitis and the nail changes in psoriatic arthritis (PsA) [1].ObjectivesTo evaluate the relationship between nail involvement and enthesopathy at DIP level in PsA patients using ultrasonography (US).MethodsWe included patients with PsA. According to OMERACT, the following elemental lesions were dichotomously (presence/absence) evaluated on greyscale US assessment at extensor tendon insertion at distal phalanx of DIP joints: abnormally hypoechoic, enthesophytes, and erosions. We also measured the tendon thickness. Increased abnormal vascularization at entheseal level was also assessed using PD technique. We also performed an US assessment of the finger nails that included the study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT) and adjacent skin (ST).ResultsWe included 33 PsA patients (323 DIP). Eleven patients (34 %) presented psoriatic onychopathy (45 fingernails) with a mean NAPSI 7 (IQR (25,75)) [2 -18]. US study of the nails revealed dystrophy in 75 nails (23%).At patient level, the mean NPT, NBT and SK were 1.90±0.22, 0.38±0.09, and 2.33±0.62, respectively.None of the patients had clinical involvement of DIP.Using US, we examined 325 extensor tendon. The mean thickness of the tendon was 0.63mm ±0.1 mm. The tendon was abnormally hypoechoic in two fingers (0.61%).Erosions were present in 16 DIP (4.9%).We found enthesophytes in 82 DIP joints at insertion of extensor digitorum tendon (25.23%).We did not observe increased abnormal vascularization at entheseal level.At finger level, the extensor tendon thickness was higher in the presence of US nail dystrophy (0.70 mm vs 0.60, p=0.01). Erosions were more common in fingers with US nail involvement (14.6 % vs 1.9%, p=0.00).Osteophytes were present in 20% of fingers with US nail involvement and 26.3% of fingers without US nail involvement (p=0.166).The thickness of DIP digital extensor tendons was correlated with the NBT(r = 0.412, p = 0.00), the NPT (r = 0.310, p = 0.00), and the thickness of the adjacent skin (r = 0.509, p = 0.00).ConclusionThe presence of US nail dystrophy was associated with thicker extensor tendon and more erosions. The thickness of the tendon was correlated with the thickness of the nail parts.This might be explained by the close relationship between nail and enthesis and supports the theory of the enthesis as an extended organ beyond the tendon bony attachment.

AB0956 To what extend is nail ultrasound discriminative between psoriatic arthritis and healthy subjects?

BackgroundClinical physical examination can detect superficial nail changes in psoriatic patients. However, the nail matrix and bed are not accessible for clinical assessment. Recently, ultrasonography (US) has emerged as a useful tool to assess nail involvement in psoriatic arthritis (PsA) patients.ObjectivesTo assess the discriminative utility of nail features detected by B-mode (BM) and color Doppler (CD) ultrasound (US) between patients with psoriatic arthritis (PsA) and healthy controls (HC).MethodsThis was a cross-sectional study including PsA patients and HC.All patients and controls underwent an US assessment of the fingernails that included the study of morphological changes based on Wortsman’s description [1]: focal hyperechoic involvement of the ventral plate without involvement of the dorsal plate (type I), loosening of the borders of the ventral plate (type II), appearance of wavy plates (type III) and loss of definition on both plates (type IV), blood flow disturbances and measurement of the thickness of nail bed (NBT), nail plate (TNP) and adjacent skin.ResultsA total of 536 nails were examined (PsA:326 nails, HC:210). Patients with PsA had significantly more morphological changes of the nails than healthy controls (23% vs 3.33%, p = 0.006).In PsA patients, the most frequently observed aspect was type III (47 nails, 14.4%), followed by type II (40 nails,12.3%) and type IV (38 nails, 11.6%). In HC, the only observed type was type (type II). US detected subclinical nail involvement in 37 healthy nails among PsA patients (11.34%). On the other hand, seven nails with clinical involvement did not demonstrate US changes: perionyxis (n=1), pitting (n=2), onycholyses (n=3), hemorrhage (n=1).The power Doppler signal of the nail bed and matrix was comparable between the groups (54% vs 61%, p= 0.603 and 41% vs 37.1%, p=0.432, respectively).NBT and skin thickness were higher in the HC group than the PsA group (1.90±0.22 mm vs 2.07±0.34 mm, p=0.047 and 2.25±0.69 vs 2.59±0.31 mm, p=0.002, respectively). While NPT was similar between the groups (0.38±0.09 vs 0.36±0.07mm, p=0.239).ConclusionUs detected morphological changes in clinically healthy fingernails in both PsA patients and healthy controls. However subclinical involvement was more common in PsA patients.Loosening of the borders of the ventral plate (type II) was the only aspect observed in HC. This would suggest that this type is not a specific feature of psoriatic nail.With regards to nail plate thickness, the measurements were similar between PsA patients and HC as previously reported by Mondal et al [2].However, unlike previous studies, we showed that the nail bed and skin thickness were significantly higher in healthy controls than PsA patients [3].

Functional Surgery for Subungual Melanoma: Surgical Tips Based on Histological Analysis of 21 Cadavers.

Amputation has been the standard treatment for subungual melanoma. Although there is growing attention toward a more conservative functional surgery, specific operative techniques are not yet available. We aimed to provide objective measurements for use in functional surgery by analyzing the anatomy of the nail apparatus obtained from 21 cadavers. Nailbed thickness was histologically measured in each subunit, and skin surface anatomy was evaluated to determine the proximal resection margin. Immunohistochemical staining was performed to analyze microvessel distribution according to the nail subunit. The nailbed thickness was the thinnest at the most proximal point of the nail matrix (thumbs, 1.10 ± 0.42 mm; big toes, 1.15 ± 0.37 mm) and the thickest at the hyponychium (thumbs, 2.86 ± 0.82 mm; big toes, 2.72 ± 0.84 mm). The distance from the eponychium to the skin surface closest to the bony cortex of extensor tendon insertion was 6.92 ± 5.13 mm in thumbs and 5.14 ± 1.59 mm in big toes. The median microvessel density was the highest at the hyponychium (25.74 vessels/mm2) and lowest at the germinal matrix (16.26 vessels/mm2) (p < .05). This histological study offers practical tips, including those to help decide the proximal and deep resection margins, in functional surgery.

Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study

BackgroundNail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups.MethodsSingle-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind.ResultsMean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001).ConclusionEchographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails.Trial registration72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations.

Subunits of the nail can be evaluated by nail ultrasonography (NUSG). The purposes of this study are to document NUSG properties (both nail-based and participant-based evaluations) in patients with psoriatic arthritis (PsA) and healthy controls and to explore the final scorings. After the literature review and a pilot study, a consensus was reached to evaluate 12 nails and 5 parameters by NUSG: nail plate impairment (NPI), nail plate thickness (NPT), nail bed thickness (NBT), nail thickness (NT), and Doppler activity (DA); further, scorings for each parameter (NPIs, NPTs, NBTs, NTs, and DAs) were calculated. Group comparisons and diagnostic performances (with ROC curve analysis) were applied to both parameters and scorings. Final scorings to predict PsA diagnosis among the NUSG scorings were reached by regression analysis. Feasibility, reliability, and clinical associations of the scores were also performed. Sixty-four patients with PsA and 26 controls (3240 baseline images) were assessed. The most affected nails, PsA/control comparisons, and the ROC analysis varied among the nails, within the higher values of PsA; therefore, 12 nails remained in the scorings. Participant-based scorings showed better content and diagnostic performances than the nail-based. Diagnostic performances, feasibility, reliability, and regression analysis of the scorings documented that NPIs, NTs, and DAs were the best. Some demographics, employee status, hemoglobin, and disease activity of the participants were associated with them. The NUSG Index (NUSGI) including NPIs, NTs, and DAs is a feasible, reliable, and discriminative method to predict PsA diagnosis, with its rich content. Clinicaltrials.gov-ID: NCT04718428.

Ultrasound characterization of the nail bed in patients with systemic lupus erythematosus

To characterize the ultrasound findings of the nail plate and nail bed in systemic lupus erythematosus (SLE) and its association with nail dystrophy. Thirty-two SLE patients, 36 patients with osteoarthritis (OA) and 20 healthy individuals were studied. High-frequency linear ultrasound was performed in nails of the second to fifth fingers in all participants. Disease activity (SLEDAI-2K index), accrued organ damage (SLICC/ACR index), autoantibody profile, and Raynaud's phenomenon were also assessed in SLE patients. Nail bed thickness in SLE patients was higher than in healthy individuals (1.25 ± 0.31 mm vs 1.17 ± 0.29 mm; P = 0.01) but lower than in OA (1.39 ± 0.37 mm; P < 0.001), while nail plate thickness was similar among groups. Nail dystrophy was found more frequently in SLE and OA than in healthy individuals. SLE patients with nail dystrophy were older than their counterparts with no dystrophy (39.4 ± 10.4 years vs 27.8 ± 5.6 years; P = 0.004), although nail dystrophy showed no association with SLICC/ACR, SLEDAI-2K, nail bed vascularity, or autoantibodies. Nail bed in SLE patients is thicker than in healthy individuals but thinner than in OA patients. Nail dystrophy in SLE is associated with advanced age, but not with accrued organ damage, disease activity, Raynaud's phenomenon, or DIP synovitis assessed by ultrasound.

Nail affection as a central part of the entheseal organ in psoriasis patients for early detection of psoriatic arthritis

Aim of the workTo evaluate nail unit and detect subclinical enthesitis at extensor tendons in psoriatic patients for early detection of psoriatic arthritis (PsA). Patients and methodsThe study included 60 PsO patients and 60 matched healthy controls. Patients underwent history, clinical examination, assessment of Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Leeds Enthesitis Index (LEI), musculoskeletal ultrasound (MSUS) both grey and power Doppler (PD) for measuring nail bed thickness (NBT), nail vessels resistive index (NVRI), extensor digitorum tendon insertion for enthesitis and distal interphalangeal joints for synovitis. ResultsPatients were 38 females and 22 males (F:M 1.7:1) with mean age 45.1 ± 13.5 years. Nail irregularities were in all cases. The mean NBT of right thumb and index were significantly increased in patients (2.3 ± 0.6 and 1.9 ± 0.4) compared to control (1.5 ± 0.2 and 1.2 ± 0.2; p < 0.001 respectively). The mean NVRI was significantly increased (0.7 ± 0.1) in cases compared to control (0.4 ± 0.1; p < 0.001). NBT > 1.8 mm would differentiate cases from control (sensitivity 76.7% and specificity 100%). Frequency of tendons hypoechogenicity and thickness were significantly increased (73% and 93.3%) in patients. A significant correlation was found between disease duration and NAPSI (r = 0.4, p = 0.04). Enthesophyte with PD significantly correlated with PASI (r = 0.6, p = 0.02). Enthesophyte without PD significantly correlated with PASI (r = 0.6, p = 0.001) and with tendon thickness (r = 0.5, p = 0.01). A significant correlation was found between NBT and LEI (r = 0.7, p = 0.01). ConclusionMSUS is an important tool for examining nail as part of the entheses in psoriasis. There is a significantly increased frequency of extensor tendon enthesopathy in fingers with involved nails.

Diagnostic role of ultrasound elastography for nail bed involvement in psoriasis

Objective:Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis.Materials and methods:Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography.Results:Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ± 9.8 years, mean PASI score was 5.53 ± 2.38, and mean NAPSI score was 33.97 ± 37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01).Conclusion:Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.

Human nail bed-derived decellularized scaffold regulates mesenchymal stem cells for nail plate regeneration.

Among hand trauma, nail bed is the most involved tissue in hospital emergency departments, resulting in the loss of nail plate, which leads to a disturbance of hand grasp function, long-lasting digit tip pain, hyperpathia, and disesthesia. Treatment of nail bed defects is a significant clinical challenge due to the lack of uniform nail bed thickness and distinct regenerative ability. In this study, it is shown that the extracellular matrix of decellularized nail bed scaffolds can play an important role in inducing bone mesenchymal stem cells to differentiate into nail epithelial cells. Using decellularized nail bed scaffolds combined with bone mesenchymal stem cells, it is revealed that the engineered nail bed can promote nude mouse nail plate regeneration ectopically. The natural extracellular matrix of decellularized nail bed scaffolds can serve as a 3D structural template for bone mesenchymal stem cell differentiation into nail-associated cells, initiating the nail plate regeneration. These results not only provide a proof-of-principle for the generation of transplantable nail grafts based on decellularized nail bed scaffolds derived from clinically wasted amputated fingers but also provide important considerations for clinical treatment for digit tip trauma.

Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis

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.

Assessment of nail unit structures by ultrasound in patients with psoriatic arthritis and their correlations with disease activity indices: a case-control study.

Ultrasound (USG) of nail was performed to assess, (1) morphological alterations of nail plates in psoriatic arthritis (PsA) patients, (2) differences of nail unit parameters [nail bed thickness (NBT), nail matrix thickness (NMT) and nail plate distance (NPD)] in PsA patients from healthy controls (3) correlation of nail unit parameters with PsA disease activity indices. Total of 895 fingernails (448 nails of 45 PsA patients and 447 of 45 controls) were evaluated by USG. Psoriasis Area and Severity Index (PASI), Disease Activity in Psoriatic Arthritis (DAPSA), and Nail Psoriasis Severity Index (NAPSI) were calculated in PsA patients. Nail unit parameters were compared between two study groups. Correlation study was done between nail unit parameters and disease activity indices. All PsA patients showed ultrasound evidence of nail plate changes (87.95% of the total fingernails and 75.34% of the clinically normal nails). Loosening of the ventral nail plate border was most common (51.79%). Mean NBT (PsA: 0.19 ± 0.035cm, control: 0.17 ± 0.018cm, p = 0.003) and mean NMT (PsA: 0.32 ± 0.041cm, control: 0.28 ± 0.031cm, p = < 0.0001) were significantly increased in the PsA patients. Moderately positive correlation was observed between NAPSI score and mean NMT (Spearman r = 0.411, 95% confidence interval: 0.125-0.634, p = 0.005). USG evidence of nail plate alterations was frequent among PsA patients, even in clinically normal nails. Increased mean nail bed and matrix thickness were noted in PsA patients. Mean NMT had a moderately positive correlation with NAPSI score.

Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis.

Aim of the Study The aim of the study was to conduct an ultrasound (US) assessment of changes in fingernails in psoriatic patients with nail involvement. Material A total of 69 patients with psoriatic changes in nails participated in the study, including 38 patients with psoriasis (Ps) and 31 with psoriatic arthritis (PsA) and 30 people in the control group. A total of 988 nails were examined. Results The thickness of the nail plate, nail bed, and matrix as shown in an ultrasound examination increased with the mNAPSI index (r=0.328, p=0.021; r=0.219, p=0.036; and r=0.422, p=0.011, respectively). The thickness of nail plate, bed, and matrix in patients with onycholysis and hyperkeratosis-type changes (concomitant or present separately) was significantly greater than when only pitting-type changes occurred (p=0.007, p=0.035, and p=0.023, respectively). An examination of nails with only pitting-type changes showed an increase in the matrix thickness compared to the control group (p=0.018). The focal hyperechoic involvement of the dorsal plate (80%) was the change most often observed in an US examination in Ps patients, whereas loosening of the borders of the ventral plate was most often observed in PsA patients. The thickness of nail bed in PsA patients increased with the duration of arthritis (r=0.399, p=0.022) and was correlated with the number of swollen digits (r=0.278, p=0.041). Conclusions The findings of this study may indicate an association of an inflammation in the nail bed with PsA development. Apart from a direct assessment of the described morphological changes of nails, a US examination could prove useful in an assessment of intensity of a local inflammation as a prognostic factor for PsA development.

Ultrasonographic characterization of the nails in patients with psoriasis and onychomycosis

ObjectiveThe study aimed at assessment of ultrasound (US) in diagnosing nail psoriasis and onychomycosis. MethodsOne hundred subjects were included: the psoriatic patients group (n=25), the onychomycosis patients group (n=25) and the control group (n=50). Nail psoriasis severity index (NAPSI) score and onychomycosis severity index were used to assess the patients, in addition to performing nail culture. The thickness of right index and thumb nail plate (NP) and nail bed (NB) was measured by US. The following parameters were also assessed: contour and echogenicity of the NP, NB focal lesions, interpolate space, distal interphalangeal joint (DIJ) changes, proximal nail fold (PNF) changes and distance between proximal NP and DIJ. ResultsThumb NP thickness in psoriasis, onychomycosis and control groups was 0.80±0.14mm and 0.77±0.21mm, and 0.61±0.09mm respectively. The thumb NB thickness in psoriasis, onychomycosis and control groups was 2.05±0.32mm, 2.13±0.32mm, and 1.79±0.23mm respectively. Psoriatic nails show preserved interplate space and DIJ changes. Onychomycotic nails show loss of interplate space proximally, swollen PNF and decreased Plate/DIJ distance. ConclusionUS nail measurements and characters can differentiate between psoriasis and onychomycosis.

Clubbed fingers: Radiological evaluation of the nail bed thickness

It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed and measured on plain radiographs of index fingers in two groups of patients: one group with lung disease and fingers clubbing and one group of normal controls. A vertical x-ray beam was used with a focus-film distance of 1.0 m, with the index finger placed in lateral view directly over the film, without anti-diffusion grid. Three investigators, blinded to prevent bias measured the thickness of soft tissues between the nail root and the terminal phalanx on the radiographs. This method was used to evaluate a group of 85 clinically clubbed (hyponychial angle > 192.0 degrees) adult patients with lung disease and a control group of a 100 normal adult individuals with no clubbing (hyponychial angle < 188.0 degrees). The mean nail bed thickness in the patients with clubbing (n = 85) was 3.88 +/- 0.55 mm (3.00-5.50 mm). In comparison, in the normal subjects (n = 100), the mean was 2.38 +/- 0.27 mm (1.75-3.10 mm), revealing a significant difference (P < 0.001). Only two normal individuals presented nail bed thickness >or=3.0 mm. A good interobserver agreement on the measurements was found (P > 0.900). The radiographic evaluation of the nail bed thickness was easily performed, with good interobserver concordance. It is possible to distinguish between clubbed from nonclubbed fingers, in vivo, using plain radiograph.