Methods of Outcomes Measurement in Nail Psoriasis

Abstract

Background: Nail involvement is a common feature of psoriasis, predicting higher disease severity and greater impairment in quality of life. Valid assessment of nail psoriasis is relevant for research and routine clinical use. However, no measurement standards have currently been developed. Objective: To identify state-of-the-art outcomes measurements in nail psoriasis by literature analysis. Methods: Systematic Web-based literature search, followed by structured critical appraisal and consecutive descriptive report. The search focused on methodological and epidemiological publications and papers describing outcomes of clinical trials on nail psoriasis. Results: Initially, 646 publications met the primary criteria. After non-relevant or replicate publications were excluded, 66 papers were analysed, including clinical trials or case reports (n = 41), reviews (n = 11) and methodological or epidemiological studies (n = 14). In total, 23 clinical outcomes measures and 15 patient-reported outcomes (PRO) tools were used. None had been validated according to recent standards. In the studies with clinical interventions (n = 41), NAPSI (Nail Psoriasis Severity Index; n = 4) or target NAPSI (n = 2) were the most often used single tools, followed by Physician’s Global Assessment (n = 3). However, in 16 studies, no specifically described outcomes measures were used. Conclusion: Valid clinical outcomes measures in nail psoriasis are rare. Existing tools lack validation and standardisation. A need exists for accurate and scientifically sound evaluation of nail psoriasis severity in trials and clinical practice. To cover all elements of nail psoriasis, the optimal nail psoriasis assessment tool would include both PRO and physician-assessed outcomes measures.

Efficacy of Ustekinumab in Nail Psoriasis and Improvement in Nail-Associated Quality of Life in a Population Treated with Ustekinumab for Cutaneous Psoriasis: An Open Prospective Unblinded Study

“…Nail involvement in psoriasis has been reported to have an impact on both functionality and emotions that can significantly affect QoL [12,13,14,15,16,17,18]. Patients participating in this study reported severe impairment in their QoL (48.15 ± 20.05) at baseline.…”

Detailed Analysis of Specific Nail Psoriasis Features and Their Correlations with Clinical Parameters: A Cross-Sectional Study

“…The NAPSI as well as patient-reported outcome tools and other physician-assessed outcome measures help to identify and evaluate the severity and features of nail psoriasis. There seems to be a need for more methodological developments in the assessment of nail psoriasis, though [10]. Most recently, promising data for the better assessment of nail disease in psoriatic arthritis have been presented by Aydin et al [20], with the use of optical coherence tomography.…”

“…Nail involvement is a common manifestation of psoriasis but the factors affecting its onset are still under investigation. Nail psoriasis occurrence considerably varies and ranges between 10 and 90% [1,2,3,4,5,6,7,8,9,10,11]. Additionally, it is reported that 80–90% of patients with psoriasis will develop nail psoriasis at some point of their lives [1,2,11,12].…”

Enthesitis in Psoriatic Disease

“…Recent work supports this view since nail disease which is associated with clinical PsA evolution is associated with a more extensive subclinical enthesopathy in psoriasis patients [49]. The importance of nail disease, the inadequacy of existing outcome measurement tools, and the need for better tools was recently highlighted [50]. In this regard, optical coherence tomography has been reported as a promising novel imaging technique for the assessment and evaluation of nail disease [51].…”