Psoriatic Nail Changes Are Associated With Clinical Outcomes in Psoriatic Arthritis

2015 ◽  
Vol 19 (4) ◽  
pp. 367-376 ◽  
Author(s):  
Matthew K. Sandre ◽  
Sherry Rohekar ◽  
Lyn Guenther
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Joint Disease ◽  
Joint Involvement ◽  
Tender Joint ◽  
Nail Bed ◽  
Nail Changes ◽  
Distal Interphalangeal ◽  
Tender Joint Counts

Background: Nail changes are common in psoriatic arthritis (PsA), with varying relationships existing between skin, nail, and joint disease. Objective: To further characterize relationships between nail changes, psoriasis, and joint involvement in PsA patients. Methods: One hundred eighty-eight PsA patients had skin, fingernail, and rheumatological assessments completed. Hand and fingernail photographs were taken and reviewed by a dermatologist. Results: Higher swollen joint counts were associated with distal interphalangeal (DIP)/periungual psoriasis ( P = .001), more splinter hemorrhages ( P = .006), and any nail bed change ( P = .03). Higher tender joint counts were associated with rough onychorrhexis ( P < .001), DIP/periungual psoriasis ( P = .03), red lunula ( P = .001), nail crumbling ( P = .046), any nail matrix ( P = .03), and nail bed change ( P = .03). Joint involvement was associated with same-digit nail changes; strongest association was swollen or tender DIP with subungual hyperkeratosis, odds ratio = 26.6 (95% CI, 5.1-139.1). Conclusion: The DIP/periungual psoriasis and specific nail changes were associated with higher joint counts and certain nail changes with same-digit joint involvement.

scholarly journals Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001450
Author(s):  
Clementina López-Medina ◽  
Anna Molto ◽  
Joachim Sieper ◽  
Tuncay Duruöz ◽  
Uta Kiltz ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Latin American ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Joint Disease ◽  
Joint Involvement ◽  
Cross Sectional ◽  
Small Joint ◽  
Musculoskeletal Manifestations ◽  
Inflammatory Bowel

ObjectivesTo characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.MethodsCross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.ResultsA total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).ConclusionThese results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

Use of ultrasound in psoriatic arthritis

2018 ◽  
Author(s):  
Gurjit S. Kaeley
Keyword(s):  
Psoriatic Arthritis ◽  
High Resolution ◽  
Imaging Techniques ◽  
Joint Disease ◽  
Joint Involvement ◽  
Close Link ◽  
Clinical Appearance ◽  
Axial Disease ◽  
Resolution Imaging ◽  
Outcome Tool

Psoriatic arthritis (PsA) is much more than just joint disease. Although previous clinical classifications have categorized by pattern of joint involvement and axial disease, imaging techniques such as MRI and ultrasound have demonstrated that not only are many more joints involved but also a wide variety of adjoining tissues. The concept of enthesitis is evolving and high resolution imaging studies are demonstrating involvement of tissues beyond just the enthesis. Many investigators have chosen to use sonographic entheseal systems designed for Spondyloarthritis in general which may not be appropriate and may lead to excess confounding by obesity. Inclusion of entheses that seem more relevant to PsA may improve the validity and specificity of the sonographic outcome tool. Nail affliction is associated with PsA, as well as enthesitis. Sonography is able to demonstrate the nail apparatus. More recent pathoanatomic findings may help explain the close link with enthesitis. Synovitis in PsA is often involved with inflammation and alteration of neighbouring structures such as the extensor tendons, palmar or plantar plates. Some investigators have proposed that inflammation in PsA may start at the entheseal sites and then spread to the joint. Dactylitis epitomizes the concept of multiple tissues involved in the digit giving rise to the clinical appearance of a uniformly swollen digit. Sonography can image many of these tissues in high resolution and offer insights into the pathophysiology of dactylitis.

15994 Tildrakizumab efficacy for psoriatic arthritis: 24-week analysis of swollen and tender joint counts and pain

2020 ◽  
Vol 83 (6) ◽  
pp. AB166
Author(s):  
Luis R. Espinoza ◽  
Rocco Ballerini ◽  
Richard Chou ◽  
Stephen J. Rozzo ◽  
Alan M. Mendelsohn
Keyword(s):  
Psoriatic Arthritis ◽  
Tender Joint ◽  
Tender Joint Counts

Psoriatic Nail Dystrophy Is Associated with Erosive Disease in the Distal Interphalangeal Joints in Psoriatic Arthritis: A Retrospective Cohort Study

2019 ◽  
Vol 46 (9) ◽  
pp. 1097-1102 ◽  
Author(s):  
Anna S. Antony ◽  
Andrew Allard ◽  
Adwaye Rambojun ◽  
Christopher R. Lovell ◽  
Gavin Shaddick ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Joint Disease ◽  
Nail Dystrophy ◽  
Chi Square ◽  
Convenience Sample ◽  
Radiographic Damage ◽  
Erosive Disease ◽  
Distal Interphalangeal

Objective.To assess whether the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal (DIP) joints.Methods.A convenience sample of patients was collated from the Bath longitudinal PsA cohort. All patients had PsA according to the ClASsification for Psoriatic ARthritis criteria (CASPAR) criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score. Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the DIP joints, and proximal interphalangeal or metacarpophalangeal (non-DIP) joints of the corresponding digits.Results.There were 134 patients included, with a median age of 53 years (interquartile range; IQR 44–61) and disease duration of 7 years (IQR 3–17). The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIP joints of the corresponding digit (OR 1.9, 95% CI 1.23–2.83; p < 0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12–2.62; p = 0.02). Nail subungual hyperkeratosis was more strongly associated with joint space narrowing, erosions, and osteoproliferation at the corresponding DIP joint compared to non-DIP joints (p < 0.001). Nail pitting was not associated with erosions or osteoproliferation.Conclusion.The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIP joints. Subungual hyperkeratosis is more strongly associated with erosive damage at the DIP than non-DIP joints. These findings support the anatomical and pathological link between nail and DIP joint disease.

scholarly journals Drug Therapies for Peripheral Joint Disease in Psoriatic Arthritis: A Systematic Review

2014 ◽  
Vol 41 (11) ◽  
pp. 2277-2285 ◽  
Author(s):  
Maria Laura Acosta Felquer ◽  
Laura C. Coates ◽  
Enrique R. Soriano ◽  
Roberto Ranza ◽  
Luis R. Espinoza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Current Literature ◽  
Therapeutic Strategies ◽  
Treatment Recommendations ◽  
Joint Disease ◽  
Joint Involvement ◽  
Evidence Based ◽  
Peripheral Arthritis ◽  
New Information

In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for peripheral joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.

Nail Enthesis Ultrasound in Psoriasis and Psoriatic Arthritis: A Report from the 2016 GRAPPA Annual Meeting

2017 ◽  
Vol 44 (5) ◽  
pp. 688-690 ◽  
Author(s):  
Joanne Szczygiel Cunha ◽  
Abrar A. Qureshi ◽  
Anthony M. Reginato
Keyword(s):  
Psoriatic Arthritis ◽  
Ultrasound Examination ◽  
Power Doppler ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Structure And Morphology ◽  
Nail Changes ◽  
Close Relationship ◽  
Distal Interphalangeal ◽  
Musculoskeletal Ultrasonography

Musculoskeletal ultrasonography is gaining favor in the evaluation of enthesitis in patients with psoriasis and psoriatic arthritis (PsA). Imaging modalities have shown that the enthesis of the distal interphalangeal joint has a close relationship to the nail itself. Studies have focused on the structure and morphology of nails to determine an association between psoriasis nail changes and the presence or severity of PsA. With the use of higher frequency probes, power Doppler (PD) can determine subclinical inflammation of the area under ultrasound examination. At the 2016 meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we proposed an ultrasonographic index for the assessment of the nail enthesis to identify the morphologic and PD findings of the nail, with the potential that both rheumatologists and dermatologists can use it to evaluate their patients.

scholarly journals Psoriatic onychodystrophy: clinical manifestations (part 1)

2019 ◽  
Vol 94 (6) ◽  
pp. 7-14
Author(s):  
A. V. Platonova ◽  
A. S. Zhukov ◽  
V. R. Khairutdinov ◽  
A. V. Samtsov
Keyword(s):  
Psoriatic Arthritis ◽  
Prognostic Value ◽  
Clinical Manifestations ◽  
Pathological Changes ◽  
Nail Bed ◽  
Nail Changes ◽  
Wide Range ◽  
Mechanisms Of Formation ◽  
The Relationship ◽  
Dystrophic Nail

Psoriatic onychodystrophy is quite common in patients with psoriasis. Changes in psoriatic nails have a wide range of clinical manifestations, including symptoms of damage of the nail bed and/or nail matrix. The article presents information about clinical and pathological manifestations of psoriatic onychodystrophy, the mechanisms of formation of pathological changes. The existence of the relationship between the change of nail plates in patients with psoriasis and the development of psoriatic arthritis is explained, the prognostic value of individual symptoms is analyzed. The diagnostic criteria for the histological diagnosis of psoriatic onychodystrophy are described. The information about the occurrence of each symptom in patients with psoriasis with dystrophic nail changes is given.

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