Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran

Zargari, Omid; Leyli, Ehsan Kazemnezhad; Azimi, Seyyede Zeinab

doi:10.1155/2018/4608490

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…The prevalence of nail involvement in our study population is lower than that observed in previous real-world studies of patients with varied prior biologic experience, which have reported rates of nail involvement ranging from 50% to 87% among patients with PsA. (33)(34)(35)(36)(37)(38)(39) Notably, approximately 31% of patients in our study population had received biologic therapy and 29% had received conventional synthetic disease-modifying antirheumatic drugs prior to enrollment, which may have ameliorated nail disease in those patients before their participation in the study. (5,26) Additionally, the majority of previous studies specifically enrolled patients with PsA and psoriasis, whereas the presence of psoriasis was not a criterion for enrollment in our study.…”

Section: Discussioncontrasting

confidence: 58%

Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Mease

Liu²,

Rebello³

et al. 2020

J Rheumatol

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Objective To examine the association of nail psoriasis with disease activity, quality of life, and work productivity in patients with psoriatic arthritis (PsA). Methods All patients with PsA who enrolled in the Corrona PsA/Spondyloarthritis Registry between March 2013 and October 2018 and had data on physician-reported nail psoriasis were included and stratified by presence vs absence of nail psoriasis at enrollment. Patient demographics, disease activity, quality of life, and work productivity at enrollment were compared between patients with vs without nail psoriasis using t-tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher exact tests for categorical variables. Results Of the 2841 patients with PsA included, 1152 (40.5%) had nail psoriasis and 1689 (59.5%) did not. Higher proportions of patients with nail psoriasis were male (51.9% vs 44.1%) and disabled from working (12.3% vs 7.8%) compared with patients without nail psoriasis (all P < 0.05). Patients with nail psoriasis had higher disease activity than those without nail psoriasis, including higher tender and swollen joint counts, worse Disease Activity in Psoriatic Arthritis and Psoriatic Arthritis Disease Activity Score values, and increased likelihood of having enthesitis and dactylitis (all P< 0.05). Patients with nail psoriasis had worse pain, fatigue, and work and activity impairment than those without nail psoriasis (all P < 0.05). Conclusion Patients with PsA who have nail psoriasis had worse disease activity, quality of life, and work productivity than those without nail involvement, emphasizing the importance of identification and management of nail disease in patients with PsA.

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Section: Discussioncontrasting

confidence: 58%

Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Mease

Liu²,

Rebello³

et al. 2020

J Rheumatol

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“…One of the limitations of the present investigation was the lack of control group to compare the rate of onychomycosis in psoriatic patients and control population; nevertheless, the majority of fungal infections in our study belonged to the nail infections (52.2%). is is less than the nail involvement reported by Jendoubi et al [28] and Zargari et al [29] which were 71.2% and 69.5%, respectively. In line with our findings, nail pitting is the most common nail matrix involvement among psoriatic patients [30].…”

Section: Discussionmentioning

confidence: 50%

Fungal Infections among Psoriatic Patients: Etiologic Agents, Comorbidities, and Vulnerable Population

Chadeganipour

Shadzi

Mohammadi

2021

Autoimmune Diseases

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Background. Psoriasis is a chronic inflammatory disorder of the skin and joint, affecting nearly 2-3% of the general population. It is assumed that imbalance between the types of natural microflora can accelerate the onset of the disease. Some fungi can play the role of superantigens and prolong chronic inflammation in the skin of psoriatic patients. The aim of the present investigation was to identify fungal species isolated from patients with psoriasis. Methods. From March 2016 to May 2019, 289 patients with prior diagnosis of psoriasis were included in this survey. Direct microscopy with potassium hydroxide (KOH 10%), culture, urea hydrolysis, hair perforation test, and growth on rice grains were used to identify clinical isolates, phenotypically. For molecular identification of Candida species and Malassezia species, PCR-RFLP and PCR-sequencing were used, respectively. Results. Forty-six out of 289 psoriatic patients had fungal infections (15.9%). Dermatophytes (54.3%), Candida spp. (19.5%), Malassezia spp. (15.2%), Aspergillus spp. (6.5%), and Fusarium spp. (4.3%) were the causative agents of fungal infections. Among Malassezia and Candida species, M. restricta (10.8%) and C. glabrata (8.7%) were the most prevalent species, respectively. Conclusion. Our findings suggested that fungal pathogens, particularly dermatophytes, may play an important role in the pathogenicity of psoriasis. Also, due to the high rate of yeast colonization in the clinical samples of psoriatic patients, concomitant use of anti-inflammatory drugs and antifungals may represent an effective therapeutic approach for better management of chronic lesions among these patients. Mycological tests should be applied to indicate the incidence of fungal diseases in psoriatic patients.

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“…The study by Zargari O et al showed a significant correlation between the psoriasis severity and the NAPSI scores. They also found a fall in PASI and NAPSI scores following treatment, though NAPSI scores fell at a slower rate [23] . The most frequent nail finding was pits seen in 43 patients (93%) followed by Onycholysis, Leukonychia, crumbling of nail Plate, and least were Splinter hemorrhage, Red spots in lunula and Beau's lines.…”

Section: Discussionmentioning

confidence: 94%

Clinical profile and severity of nail involvement in psoriasis

Rao¹,

Yakkala²

2021

Int. J. Dermatol. Venereology Leprosy Sci.

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Introduction: Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy. Material and Methods: This is prospective and observational study conducted in the Department of Dermatology. Dermatological examination specified the clinical form of psoriasis, nail alterations type, and number of fingernails involved, the Psoriasis Area and Severity Index (PASI) score assessing the severity of skin involvement, and based on PASI score, patients were classified into mild (PASI<10), moderate (PASI 10-20), and severe disease (PASI>20). Nail Area Psoriasis Severity Index (NAPSI) score assessing the severity of nail involvement (pitting, leukonychia, red spots in lunula, and nail plate crumbling) and for nail bed disease (oil drop [salmon patch] discoloration, onycholysis, nail bed hyperkeratosis, and splinter hemorrhage). Results: A total of 70 patients were examined. Of the 70 cases, male preponderance was noted. Thirtyfive had early-onset psoriasis and the other 35 had late-onset disease. 48/70 (73%) patients with psoriasis had nail involvement. Among patients with nail involvement as well as those without nail involvement, the patients with mild psoriasis (PASI<10) accounted for the majority (31/48 [64.2%] and 18/22 [81.8%], respectively). Patients with moderate psoriasis accounted for 33.3% (14/48) of those with nail involvement and 9.0% (2/22) of those without nail involvement. Those with severe psoriasis (PASI>20) accounted for 10.4% (5/73) of patients with nail involvement. The most common finding among those with nail changes was pitting (33/48, 89.5%). Other common changes were leukonychia (27/48, 56.2%), Red spots in lunula (3/48, 6.25%), Splinter hemorrhage (9/48, 18.7%), Beau's lines (6/48, 12.5%), and Rough nails (18/48, 37.5%). Conclusion:The most frequent signs of nail matrix disease are pitting, leukonychia, crumbling, and red spots in the lunula, whereas salmon patches or oil spots, subungual hyperkeratosis, onycholysis, and splinter hemorrhages represent changes of nail bed psoriasis. The treatment of nail psoriasis is prolonged with both conventional and biologic therapies and the systemic side effects of the various therapies limit their use. Hence, it requires patience both on the part of the treating dermatologist and the patient.

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Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran

Cited by 11 publications

References 25 publications

Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

Fungal Infections among Psoriatic Patients: Etiologic Agents, Comorbidities, and Vulnerable Population

Clinical profile and severity of nail involvement in psoriasis

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