Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease

Alvarado, Patricia Moya; Crespo, Esther Roè; Muñoz-Garza, Fania Zamantta; López‐Ferrer, Anna; Alonso, Ana; Rull, E. Vilarrassa; Pou, J. Casademont i; Puig, L.

doi:10.1111/jdv.15035

Cited by 22 publications

(23 citation statements)

References 25 publications

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“…Even though the majority of studies have reported increased PD signal in the NB and NM of psoriatic patients [11,13,14,32,36,40], capillaroscopic evaluation of the proximal nailfold of these patients has shown decreased number and diameter of capillaries and increased vessel tortuosity [41,42]. In our study, the grade of NMPD signal and PD assessed in the NB and NM together failed to reveal differences between groups and the NBPD signal was more frequently absent in the PsA group.…”

Section: Discussioncontrasting

confidence: 72%

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

et al. 2021

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Background Nail 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. Methods Single-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. Results Mean 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). Conclusion Echographic 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 registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

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Section: Discussioncontrasting

confidence: 72%

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

et al. 2021

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“…This is the first study, to our knowledge, that has assessed the relationship between nail disease and systemic peripheral enthesitis in established PsA. A previous study in psoriasis and pre-articular disease did not find a significant correlation between DIP enthesitis and Achilles tendon enthesitis [ 13 ]. In this study, we attempted to assess enthesitis both peripherally, at multiple sites, and at all fingers.…”

Section: Discussionmentioning

confidence: 89%

The relationship between the nail and systemic enthesitis in psoriatic arthritis

Elliott

Pendleton

Wright

et al. 2021

Rheumatology Advances in Practice

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Objective Psoriatic nail disease is more common in PsA than in isolated skin psoriasis (PsO). The nail is closely integrated to the DIP joint entheses. US data have shown that those patients with nail disease in PsO are more likely to have systemic enthesitis. We examined whether there was a relationship between nail disease, DIP enthesitis and systemic enthesitis in established PsA. Methods Forty-six PsA participants with nail disease underwent US scanning of the nail unit and the DIP entheses along with peripheral entheseal sites according to the Madrid sonographic enthesitis index (MASEI). Results At the finger level, there was a mild to moderate correlation between nail US changes and both clinical nail disease and DIP enthesis changes (DIP US) [Spearman correlation (rS) = 0.30, P < 0.001 and rS = 0.16, P < 0.001, respectively]. At the patient level, there was a moderate correlation between the nail US score and nail psoriasis severity index score and DIP US (rS = 0.33, P = 0.024 and rS = 0.43, P = 0.003, respectively). At the patient level, there was also a positive correlation between a higher nail US score and the active peripheral enthesitis score (MASEI-active) (rS = 0.35, P = 0.018). When power Doppler was part of nail US score, similar results were demonstrated at both the finger and patient levels. Conclusion This study has demonstrated the utility of nail US imaging and the close relationship, on scanning, between the DIP entheses and the nail unit. In PsA, we have seen a correlation between active US changes at the nail and peripheral enthesitis, which requires further analysis. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT03955861.

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“…Development of NP may be the first sign of joint disease resulting from subclinical enthesitis in the closely anatomically associated entheses of the DIP extensor tendons(Figures 1, 4) (18,(53)(54)(55). This hypothesis is supported by results from several recent imaging studies showing that changes in the DIP joint capsule are closely linked to histologic nail changes and diffuse inflammatory responses extending from the enthesis to the nail (10,15,16,56,57). Specifically, patients with psoriasis with nail involvement have higher enthesopathy scores on ultrasound than patients without nail disease, as a result of entheseal thickening of the extensor tendon (16,56,57).…”

mentioning

confidence: 69%

“…This hypothesis is supported by results from several recent imaging studies showing that changes in the DIP joint capsule are closely linked to histologic nail changes and diffuse inflammatory responses extending from the enthesis to the nail (10,15,16,56,57). Specifically, patients with psoriasis with nail involvement have higher enthesopathy scores on ultrasound than patients without nail disease, as a result of entheseal thickening of the extensor tendon (16,56,57). Several studies have shown positive correlations between NAPSI scores and ultrasound evidence of enthesopathy (56,58).…”

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confidence: 70%

Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs

et al. 2021

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Objective An estimated 40%–50% of patients with psoriasis have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (eg, enthesitis, arthritis) and we review targeted therapies for nail psoriasis. Methods We performed a literature search to identify which systemic therapies approved for the treatment of psoriasis and/or psoriatic arthritis (PsA) have been evaluated for the treatment of nail psoriasis, either as a primary or secondary outcome. A total of 1546 articles were identified on February 18, 2019 and evaluated for relevance. Results We included findings from 66 articles on systemic therapies for the treatment of nail psoriasis in psoriatic disease. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Severity Index, there was a high level of methodological heterogeneity across studies. Conclusion Nail psoriasis is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat nail psoriasis to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized nail psoriasis scoring systems and well-defined treatment guidelines to improve management of psoriatic disease.

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Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease

Cited by 22 publications

References 25 publications

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

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

The relationship between the nail and systemic enthesitis in psoriatic arthritis

Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs

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