TECHNOLOGICAL METHODS USED IN THE PRODUCTION OF THE DOSAGE FORM "NAIL LACQUER"

Therapy of nail disease is determined by the type of disease. We do not even think about how vulnerable and susceptible to various diseases our nails are. A number of diseases involve the use of local medicines. One of the dosage forms intended for topical use are medicinal lacquers. This article is devoted to the consideration and evaluation of the functional characteristics of excipients in the technology of medicinal lacquers.

Fungal Viability of Nail Dust from Onychomycosis Abrasion: A Pilot Study

<b><i>Introduction:</i></b> Onychomycosis is a frequent complaint in dermatological practice and corresponds to the most common nail disease. The treatment of onychomycosis remains a challenge, as several factors end up compromising and making treatment difficult. Nail abrasion is considered a useful method in many cases. However, there is controversy about this approach, as there is an aerosol formation that could contaminate the environment and cause fungal changes or hypersensitivity reactions by the disseminated dust. We conducted a pilot study to investigate the fungal viability of nail particles from nails with onychomycosis after abrasion procedure. <b><i>Methods:</i></b> In this study, nail dust from the gloves and mask, used in the procedure, was collected from 9 patients with clinical and dermoscopic diagnoses of onychomycosis. <b><i>Results:</i></b> Hyaline septate hyphae were found in 12 materials (gloves and/or masks) from 7 patients. However, these hyphae were morphologically deformed or mutilated in all exams. In Mycosel® agar, there was no growth of any fungus. <b><i>Discussion/Conclusion:</i></b> The absence of dermatophyte isolation in all fungal cultures may demonstrate that the deformed fungal structures shown are not viable and would not present risks of contamination after nail abrasion.

AB0576 BONE EROSION IN PSORIATIC ARTHRITIS ASSOCIATED WITH PSORIASIS DURATION, SKIN, NAIL AND JOINT DISEASE SEVERITY

Background:Psoriatic arthritis (PsA) is heterogeneous in its clinical presentation and disease course, but many patients (pts) develop a destructive form of arthritis. Psoriasis (PsO) precedes arthritis by an average of 7 years. [1]. Theory of transition from PsO to PsA has been proposed recently [2]. But association between skin disease severity and joint disease are still unclear.Objectives:to evaluate association between bone erosion, PsO duration, skin and nail disease severity in PsA pts based on data from clinical practice (RU-PsART cohort).Methods:737 (M/F=350/387) PsA pts fulfilling the CASPAR criteria were included. Mean age 47.4±12.7 years (yrs), PsA duration 55[17;120] mos., PsO duration 165[74.5;292] mos., mean DAPSA 23.3[14;36.9] mos., HAQ-DI - 0.98 [0.5;1.38], CRP - 7.4 [2.1;18] mg/l. All pts underwent standard clinical examination (tender joins count (TJC)/68, swelling joints count (SJC)/66, CRP (mg/l), DAPSA, dactylitis, enthesitis by LEI + Plantar Facia (PF), HAQ-DI. Mild disease was defined as body surface area (BSA)≤10%, moderate to severe as BSA>10%. The presence/absent of nail PsO was evaluated. X-ray of feet and hand were done in 622 out of 737 pts. The one-factor model of logistic regression was used to identify a group of features that are associated with achievement MDA. M±SD, Me [Q25; Q75], Min-Max, %, t-test, Pierson-χ2, Manna-Whitney tests, ORs with 95% CI were performed. All p<0.05 were considered to indicate statistical significance.Results:PsO precedes of PsA by an average of 9.2 years. BSA≤10% was found in 615 out of 672 pts (91.5%), BSA>10% - in 57 out of 672 pts (8.5%). Nail PsO were seen in 230 out of 737 (31.2%). Bone erosion was found in 237 out of 622 of pts (38.1%). Among these pts nail PsO were seen in 67 out of 237 pts (28.3%). Enthesitis found in 236 out of 737 pts (42.1%), dactylitis – in 197 out 731 pts (27%), axial PsA – in 315 out of 731 pts (43.1%). Bone erosion significantly associated with PsO duration more than 5 yrs., skin and nail PsO severity, high PsA activity by DAPSA, axial manifestation and duration of PsA > 36 mos. (Figure 1).Figure 1Forest plot of factors associated with bone erosion in PsA pts.Conclusion:In our cohort the majority of PsA pts had mild PsO preceded PsA on average of 9.2 yrs. Bone erosion was found in 30% of PsA pts which associated with PsO duration, skin and nail disease severity as well as with PsA activity. Early diagnosis and therapeutic intervention within a “window of opportunity” are very important for improving outcomes and prevent structural damage in PsA.References:[1]Tillett W, et al. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort. Rheumatol. 2017; 56, 2109–2113[2]Scher JU, et al. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol. 2019;15(3):153-166. doi: 10.1038/s41584-019-0175-0. PMID: 30742092.Disclosure of Interests:None declared.

AB0581 NAIL PSORIASIS AMONG PATIENTS WITH PSORIATIC ARTHRITIS IS MORE ASSOCIATED WITH THE SEVERITY OF SKIN PSORIASIS THAN WITH FEATURES OF SEVERE ARTHRITIS

Background:Nail disease is an important feature of psoriasis arthritis (PsA), and has been recognised as one of the 6 important clinical domains by GRAPPA. Little is known about how patients with PsA and nail disease compare to patients without nail disease. Nail disease has been found to associate with severe PsA.Objectives:The objective of this study was to examine the association of nail disease with patient demographics and features of active psoriasis and PsA.Methods:For this cross-sectional study, data from 3 PsA cohorts was studied (St Vincent’s University Hospital Dublin, Ireland; University Hospital Kerry, Ireland; and Fatima Memorial Hospital Lahore, Pakistan). Following informed consent, patients underwent detailed skin and rheumatologic assessments including disease activity measures. Since a large number of patients were in clinical remission at the time of assessment, we made 2 documentations of reversible clinical variables (e.g., current skin scores (PASI), current nail disease, current tender and swollen joint counts, current enthesitis, current dactylitis) at the time of study entry and, through extensive medical record review, we identified patient’s maximum skin and joints disease activity scores ever documented, e.g., maximum skin scores (PASI max), TJC max, SJC max, nail disease ever, dactylitis ever, enthesitis ever. Nail disease was stratified by the presence or absence of nail psoriasis.Results:Data on 476 PsA patients was assessed (age 53.8±10.8, PsA duration 13.9±10 years, BMI 29±5; current PASI 2.5±3.2, current TJC 1.8±2.6 years, current SJC 1.4±2.2 years; 37% of the cohort had enthesitis ever, 46% had dactylitis ever, 30.7% had current dactylitis, and 28% with current enthesitis). 63.4% (n=302) of the cohort ever had nail disease, and 45.4% (n=216) had current nail disease at the time of assessment. On univariate analysis, significant or marginally significant statistical association of current nail disease was noted with current PASI (p<0.001), enthesitis ever (p=0.004), current enthesitis (p=0.11), dactylitis ever (p=0.027), current dactylitis (p=0.07), MDA not achieved (p<0.001), current SJC (p=0.08), and current TJC (p=0.32); however, no statistical association was noted with age, gender, disease duration, smoking status, low education status.The following variables were included in multiple stepwise regression analysis: current PASI, current enthesitis, current dactylitis, current TJC, current SJC, MDA not achieved, and low education status; a significant association of current nail disease was noted with current PASI (OR 2.2, CI 1.83-2.54, p<0.001) with a borderline association of current dactylitis (OR 1.6, CI 0.94-2.58, p=0.083). When we used nail disease ever as a dependent variable in the multiple regression model using covariates of PASI max, TJC max, SJC max, dactylitis ever, enthesitis ever, MDA not achieved and low education status, a significant association of nail disease ever was noted with PASI max (OR 1.09, CI 1.01-1.17, p=0.01), TJC max (OR 1.08, CI 1.02-1.14, p=0.005) and borderline association with dactylitis ever (OR 1.74, CI 0.96-3.15, p=0.067)Conclusion:The presence of nail disease among patients with PsA is significantly associated with severity of skin psoriasis with only borderline associations with measures of active musculoskeletal involvement.Disclosure of Interests:Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, shehla farrukh: None declared., Shabnam Batool: None declared., Sadia Asif: None declared., Oliver FitzGerald Speakers bureau: Abbvie, Janssen, Pfizer, Consultant of: BMS, Celgene, Eli Lilly, Janssen, Pfizer, Grant/research support from: Abbvie, BMS, Eli Lilly, Novartis, Pfizer.

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

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.