Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis

Idolazzi, Luca; Gisondi, Paolo; Fassio, Angelo; Viapiana, Ombretta; Giollo, Alessandro; Rossini, Maurizio; Girolomoni, Giampiero; Gatti, Davide

doi:10.11152/mu-1327

Cited by 24 publications

(23 citation statements)

References 36 publications

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“…Several authors have shown that NPT, NMT, and NBT were greater in psoriatic patients than controls [9,11,13,14,32,[34][35][36][37][38]. The present study only detected this increase in NPT.…”

Section: Discussioncontrasting

confidence: 67%

“…US examination can detect many changes to psoriatic nails, even in the absence of clinical findings [9][10][11][12][13]. Wortsman et al described and classified 4 types of US TS changes, ranging from the earliest to the most severe: 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) (Fig.…”

Section: Introductionmentioning

confidence: 99%

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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: 67%

Section: Introductionmentioning

confidence: 99%

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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“…However, magnetic resonance can also be used in some specific situations, especially when periungual soft tissues and bone involvement need to be further evaluated . In psoriasis, nail plate thickness can be useful in discriminating between patients with psoriatic nail involvement and healthy controls . Hypervascularity, viewed as an increase in Doppler signal, is related to increased disease activity .…”

Section: Discussionmentioning

confidence: 99%

“…Existing studies on nail psoriasis are based on ultrasound and magnetic resonance evaluation . To our knowledge, there is no investigation of elastography.…”

Section: Introductionmentioning

confidence: 99%

Evaluating nail thickness and stiffness with shear‐wave elastography in nail psoriasis: A preliminary study

İslamoğlu

Uysal

Demirbaş

et al. 2019

Skin Research and Technology

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Psoriasis is a chronic inflammatory disease affecting up to 3% of the general population. The disease is multifactorial; genetic and environmental factors play a role in the pathogenesis. 1 Nail involvement is observed in 10% of psoriatic patients, but the risk of occurrence of such changes during a patient's lifetime may be as high as 80%-90%. 2 Nail psoriasis has a significant negative impact on quality of life, and it may also be considered an indicator for patients at risk for future psoriatic joint damage. 3,4 The severity of nail psoriasis is evaluated using the Nail Psoriasis Severity Index (NAPSI). This index evaluates the matrix of each nail from 0 to 4 (pitting, leuconychia, red spots in the lunula, and nail plate crumbling) and the bed of each nail from 0 to 4 (onycholysis, splinter haemorrhages, subungual hyperkeratosis and oil spot/salmon patch). Although NAPSI is an objective and reproducible tool for calculating the degree of nail involvement, it is time-consuming. 5 Ultrasound is a useful, non-invasive and inexpensive imaging tool for screening superficial tissues, such as nails. 6,7 Shear-wave elastography (SWE) is a newer, cost-effective diagnostic ultrasound technique that assesses tissue stiffness and thickness. It has many advantages, such as real-time B-mode imaging, lack of operator

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“…Unfortunately, in our study images gained from d1 and nd1 had insufficient quality, although repeated attempts to visualize these NU were performed. The difficulties were related to the limitations of our probe (inability to fit the (18)(19)(20). The pioneers of a nail plate thickness analysis using ultrasound transmission time were Finlay et al (21).…”

Section: Hf-usgmentioning

confidence: 99%

High-Frequency Ultrasonography and Evaporimetry in Non-invasive Evaluation of the Nail Unit

et al. 2021

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Background: The nail unit (NU) is a complex structure that performs a number of functions, including protection, defense, manipulation, and palpation. Non-invasive research methods can facilitate the recognition of NU structure and function. Evaporimetry and HF-USG due to their availability of equipment and low research costs seem to be particularly noteworthy, but so far have been assessed to a limited extent. The aim of the presented study was to check the usefulness of TOWL and HF-USG in examination of NU.Materials and Methods: A total of 58 volunteers aged 25–65 years (mean age: 41 ± 10.16 years) were qualified for the study. The subjects did not present symptoms of clinically evident onychopathy and did not suffer from any dermatoses associated with lesions occurring within the NU. Additionally, the patients did not suffer from systemic diseases that could affect NU (including heart, lung, and endocrine diseases). In all volunteers, the measurement of TOWL and 20 MHz ultrasonography [high-frequency ultrasonography (HF-USG)] with the special emphasis on determination of nail plate thickness were performed.Results: Analysis of 464 HF-USG images revealed that the nail plate presented as two hyperechoic, parallel streaks (railway sign) with a linear hypoechoic middle layer between them. Matrix was visualized as a hypoechoic structure with blurred boundaries, mostly within the fourth and fifth fingers and more often in women. We found statistically significant correlations between the type of a finger and the thickness of the nail plate both in the entire study group and taking into account gender. In the dominant hand, the results were r = −0.341; p < 0.001; r = −0.417, p < 0.001; and r = 0.337; p = 0.001 (for the whole group, for women, and for men, respectively). In the non-dominant hand, the results were r = −0.465; p < 0.001; r = −0.493, p < 0.01; and r = −0.503; p < 0.01 (for the whole group, for women, and for men, respectively). There were statistically significant differences in the thickness of the nail plates of the corresponding types of fingers between female and male NUs. Statistically significant correlations were found between the type of a finger and the TOWL value in the whole group and taking into account gender (p < 0.05), except for the non-dominant hand in men. There were no statistically significant differences in the TOWL values of the corresponding types of fingers between male and female NUs (p > 0.05). There was no statistically significant correlation between the TOWL value and the nail plate thickness in any of the tested NUs, apart from the one statistically significant correlation in nd5 (r = 0.390, p = 0.021).Conclusions: To sum up, non-invasive methods, such as HF-USG and TOWL, enable assessment of the NU and are useful in examination of its structure and function. HF-USG shows characteristic elements of NUs that can be distinguished because of differences in their echogenicity. The thickness of the nail plate and TOWL depend on the type of finger, and show a relationship with gender.

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Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis

Abstract: Our study shows that ultrasonography may be a potential advantage in clinical practice. Our results strengthen the information already available in the literature and add quantitative parameters for ultrasonography of the nail.

Cited by 24 publications

References 36 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

Evaluating nail thickness and stiffness with shear‐wave elastography in nail psoriasis: A preliminary study

High-Frequency Ultrasonography and Evaporimetry in Non-invasive Evaluation of the Nail Unit

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