A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations

Kasman, Sevtap Acer; Gezer, Halise Hande; Baklacioglu, Hatice Sule; Gürsoy, Didem Erdem; Duruöz, Mehmet Tuncay

doi:10.1016/j.jbspin.2021.105197

Cited by 7 publications

(12 citation statements)

References 27 publications

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“…1, and identi ed a signi cant difference between control and psoriatic participants, the latter of whom had higher values. This difference was also found by Sandobal et al [16] between patients with psoriasis or psoriatic arthritis and healthy controls or those with rheumatoid arthritis, as well as in a comparison of patients with psoriatic arthritis and controls in subsequent studies [12,15,23]. In the present study, we did not nd such a difference in nail bed thickness between patients with psoriatic arthritis and controls (1.79 versus 1.67 mm; p = 0.073), in agreement with the ndings of De Rossi et al [14].…”

Section: Wortsman Et Alsupporting

confidence: 81%

“…Aydin et al [13] and Kasman et al [12] identi ed greater total nail thickening in psoriatic patients (psoriasis and psoriatic arthritis) than in controls, and Kasman et al [12] con rmed this nding for patients with psoriatic arthritis, while De Rossi et al [14] did not nd such a difference between the psoriatic groups and controls. Aydin et al [13] and Mondal et al [15] identi ed a higher mean matrix in patients with psoriatic arthritis than in controls, and Acquitter et al [29] found greater matrix thickening in patients with clinically present nail psoriasis.…”

Section: Reliability (Agreement) Of the Two Examiners Regarding Quant...mentioning

confidence: 98%

“…According to Mondal et al [15], who also evaluated the 10 ngers of the hands, the right thumb was also the nger that most frequently presented with Wortsman's alterations (93.33%). Acer Kasman et al [12], who evaluated 12 digits (including the 2 halluces), found that the most discriminative ngers varied according to the parameter, each of which was evaluated individually: the left thumb for the nail plate index, the fth nger of the left hand for nail bed and total thickening, and the third nger of the right hand for Doppler activity; in contrast, Mendonça et al [23] found that the second and third ngers had the greatest changes on spectral Doppler and the lowest resistivity index, respectively. Undoubtedly, when evaluating all the ngers, the examination time is longer, which can reduce the number of people willing to participate in the study.…”

Section: Wortsman Et Almentioning

confidence: 99%

“…The earliest nail alterations that can be observed on US are those of the morphology of the ventral plate, which loses its hyperechoic de nition and presents with focal irregularities with hyperechoic deposits [12,15,19,23,26].…”

mentioning

confidence: 99%

“…When used as a test to help better de ne disease activity, the ultrasound evaluation of the nails of patients with psoriatic arthritis, together with previously validated clinical scores, may help in making therapeutic decisions for this multifaceted disease. It is still necessary to de ne which ngers and nail ultrasound parameters to consider, since there is great variability in the literature (for example, whether 2 to all ngers plus the halluces should be included), and none of the selections have been validated to date [12][13][14][15][16]18]. Our study aims to contribute to the eld by seeking to describe the most signi cant sonographic changes, the most affected ngers and whether there is an association between nail US ndings and previously used clinical scores (NAPSI, ankylosing spondylitis disease activity score with Creactive protein (ASDAS-CRP), minimal disease activity (MDA), and disease activity index for psoriatic arthritis (DAPSA).…”

mentioning

confidence: 99%

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Ultrasound Nail Assessment in Patients With Psoriasic Arthritis: Is There a Correlation of Findings With Clinical Scores?

MEHL,

SCHMIDT,

AZEVEDO

2023

Preprint

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Background: Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings. Objectives: To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)). Methods: This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, and identify synovitis of the distal interphalangeal joints and the presence of a power Dopplersignal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statisticsv.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA and MDA were calculated. Spearmancorrelation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification. Results: The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p<0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and osteophytes in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p<0.001). There was a correlation between ultrasound nail involvement and the NAPSI score, between the number of fingers and mean change in the nail plate and the ASDAS-CRP (p=0.034, p=0.030), and between the DAPSA (remission/low activity versus moderate/high activity) and the mean change in the nail plate (p<0.013). Conclusions: Nail ultrasound has the potential to assist in the monitoring of disease activity in patients with psoriatic arthritis.

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Section: Wortsman Et Alsupporting

confidence: 81%

Section: Reliability (Agreement) Of the Two Examiners Regarding Quant...mentioning

confidence: 98%

Section: Wortsman Et Almentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Ultrasound Nail Assessment in Patients With Psoriasic Arthritis: Is There a Correlation of Findings With Clinical Scores?

MEHL,

SCHMIDT,

AZEVEDO

2023

Preprint

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Ultrasound Assessment of Psoriatic Arthritis Patients With Clinically Normal Nails and Evaluation of its Correlation With the Disease Activity

Mahmoud,

Rouached,

Rahmouni

et al. 2024

J of Ultrasound Medicine

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ObjectivesNail unit is one of the targets of ultrasound (US) assessment. We aimed to compare ultrasound parameters of clinically normal nail unit in psoriatic arthritis (PsA) patients with healthy controls (HC) and evaluate their correlations with disease activity.MethodsThis was a cross‐sectional study including patients with PsA and matched HC. Tender (TJC) and swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and Disease Activity in Psoriatic Arthritis (DAPSA) were collected in PsA patients.Patients underwent US assessment of fingernails with a study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT), and adjacent skin (ST). Correlation between nail unit parameters and disease activity was studied.ResultsWe evaluated 22 PsA patients (219 nails) and 21 HC (210 nails). Mean DAPSA was 21.56 ± 14.36 and mean PASI was 2.19 ± 3.8.PsA patients had more US morphological changes than HC (16.89 vs 3.33%, P = .03). NPT comparison between identical fingernails of PsA and HC did not reveal significant difference. However, NBT was significantly higher in HC (1.77 vs 2.07 mm, P = .027) as well as ST (2.26 vs 2.59 mm, P = .003).TJC and ST were positively correlated (r = .46, P = .03). No correlation was noted between disease activity scores and NPT, NBT, or ST in PsA patients. In biologic parameters, ESR was negatively correlated with ST (r = −.41, P = .05).ConclusionsNail bed and adjacent skin US morphological changes were contributive to distinguish psoriatic from healthy nails. Adjacent skin thickness measurement was positively correlated with TJC and ESR, suggesting that it could be used as an indicator of disease activity in PsA.

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Ultrasound of Nail Conditions

Wortsman

Corredoira

Pizarro³

et al. 2022

Textbook of Dermatologic Ultrasound

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A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations

Cited by 7 publications

References 27 publications

Ultrasound Nail Assessment in Patients With Psoriasic Arthritis: Is There a Correlation of Findings With Clinical Scores?

Ultrasound Nail Assessment in Patients With Psoriasic Arthritis: Is There a Correlation of Findings With Clinical Scores?

Ultrasound Assessment of Psoriatic Arthritis Patients With Clinically Normal Nails and Evaluation of its Correlation With the Disease Activity

Ultrasound of Nail Conditions

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