Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis

Abstract

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.

Ixekizumab and Ustekinumab Efficacy in Nail Psoriasis in Patients with Moderate-to-Severe Psoriasis: 52-Week Results from a Phase 3, Head-to-Head Study (IXORA-S)

“…Nail psoriasis is also prevalent in patients with psoriatic arthritis (PsA), and it has been considered a predictor for the development of PsA [2][3][4][5]. Nail psoriasis can cause pain and can impair hand mobility [6].…”

Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis

“…In the current study, a US assessment was made of patients with existing DIP joint extensor enthesopathies. To date, few reports have been published on a US assessment of the nail apparatus [18,19,20,21]. We have previously used ultrasound to show a high frequency of subclinical entheseal involvement in DIP joint in patients with Ps [21].…”

“…To date, few reports have been published on a US assessment of the nail apparatus [18,19,20,21]. We have previously used ultrasound to show a high frequency of subclinical entheseal involvement in DIP joint in patients with Ps [21]. In our previous study in patients with Ps and PsA, loss of normal fibrillary architecture, enthesophytes, and bony changes were observed in 31% and 68% digits with nail involvement, respectively [21].…”

“…We have previously used ultrasound to show a high frequency of subclinical entheseal involvement in DIP joint in patients with Ps [21]. In our previous study in patients with Ps and PsA, loss of normal fibrillary architecture, enthesophytes, and bony changes were observed in 31% and 68% digits with nail involvement, respectively [21]. In a study by Castellanos-González et al, the frequency of changes in the digital extensor tendon or its attachment in the DIP joint of digits with nail involvement was nearly 83% [22].…”

A preliminary study of post-progressive nail-art effects on in vivo nail plate using optical coherence tomography-based intensity profiling assessment

“…Recently, several techniques have been applied for the assessment of nail disorders. Ultrasound imaging has been used by several research groups to describe, measure, and detect morphological features and changes of the nails in patients with psoriatic and/or psoriatic arthritis [13][14][15][16][17] . But the ultrasound imaging system has low axial and lateral resolutions and it requires the use of a gel as a coupling agent 15,17,18 .…”