The use of ultrasonography in the diagnosis of nail disease among patients with psoriasis and psoriatic arthritis: a systematic review

Abstract

Background: Nail involvement has been described as a key clinical feature for both psoriasis (PsO) and psoriatic arthritis (PsA) and is an important risk factor in PsA. Thus, early diagnosis of nail involvement may be essential for better management of PsO and PsA. Ultrasonography is considered a highly promising method to visualize nail disease. The main aim of this review was to evaluate the use of ultrasonography for the diagnosis of nail disease in patients with PsO and PsA by reviewing ultrasound parameters with the best diagnostic accuracy. Main body of the abstract: A systematic search was performed in MEDLINE via the PubMed and LILACS databases. Conference proceedings of relevant rheumatology scientific meetings were also screened. Results: After applying eligibility criteria, only 13 articles and 5 abstracts were included in this review. The selected studies showed a huge variability in evaluation methods (and therefore in the results) and were mainly focused on the assessment of nails ultrasound parameters that may differ among patients and healthy controls, especially the morphological aspects in B-mode ultrasonography and vascularization of the nail bed by Doppler ultrasonography. Our research indicated that the evaluation of nail disease in PsO and PsA is still underrepresented in the literature, probably reflecting a restricted use in clinical practice, despite the widespread use of ultrasonography in the management of chronic arthritis. Short conclusions: Despite the potential relevance of ultrasonography for the diagnosis of nail disease, additional studies are needed to determine which features are more reliable and clinically pertinent to ensure accuracy in the evaluation of nail involvement in PsO and PsA.

Can spectral doppler high specificity and gray scale nail assessment suggest inflammation in psoriatic arthritis patients and control groups?

“…A systematic review showed studies that characterize PD and sD measurements, but still no other paper had analyzed completely the cut-off point, defining the correlations between clinical findings, GS, PD and sD in nail entheses of PsA patients and control groups. 29 At this point it is also important to point out limitations of the present study. The cross sectional design of our protocol precludes establishing a cause-effect association between sD findings and PsA pathophysiology.…”

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

“…Ultrasonography can be employed as a method for early detection and careful characterization of the inflammatory process in different anatomical structures and different stages of the disease in patients with PsO and PsA [11]. Since the nail apparatus can be considered a part of the musculoskeletal system and a link between joint and tegument [31], US nail evaluation has emerged as a promising tool for early identification of nail psoriasis, as a possible technique for distinguishing PsO from PsA patients and for differentiating psoriatic patients from control group patients [6].…”

“…Ultrasonography (US) is considered a highly promising method to visualize nail disease. However, there is no consensus yet about which parameters and features can provide accuracy in the evaluation of nail psoriasis [6].…”

Recommendations for management of childhood psoriasis

“…[ 35 ] Nail ultrasound including power doppler and spectral doppler ultrasound can measure the thickness of ventral and dorsal nail plates, nail bed, loss of definition, morphological changes and blood flow disturbances. [ 36 ]…”