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

Abstract

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.

Nail disease in psoriatic arthritis. Data from the Russian Psoriatic Arthritis Registry

“…Следует подчеркнуть, что наличие у пациента Пс ногтей считается фактором неблагоприятного прогноза в отношении развития эрозивного артрита и маркером тяжелого течения ПсА [12]. Пс ногтей также является предиктором аксиального поражения [13].…”

“…Patients with nail psoriasis had more severe erosive peripheral arthritis compared to patients without nail psoriasis. Median TJC was 8 [4][5][6][7][8][9][10][11][12][13][14][15] vs 5 [2][3][4][5][6][7][8][9][10][11][12] (р=0.002), SJC -5 [1][2][3][4][5][6][7][8][9] vs 2 [0-7] (р=0.003), and erosive radiographic arthritis of feet was found in 45.0% vs 31.2% of patients (р=0.003) respectively. Group 1 patients had higher disease activity measured by DAPSA -25 vs 20 (p=0.001) and ASDAS-CRP -3.1 [2.2-4.0] vs 2.8 [1.8-3.5] (р=0.004), compared to group 2 patients.…”

“…Patients with nail psoriasis significantly more often had moderate and severe skin psoriasis according to BSA, compared to patients without nail psoriasis (39.9% vs 26.1% and 14.8 vs 1.1% respectively; р<0.01 for both comparisons); group 2 patients significantly more often had limited skin psoriasis compared to group 1 patients -in 72.8% vs 45.3% of cases respectively (р<0.01). Median PASI index in groups 1 and 2 was 6 [2][3][4][5][6][7][8][9][10][11][12][13][14] vs 3 [1][2][3][4][5][6] respectively (р<0.01). Group 1 patients gave worse assessment of their disease than group 2 patients; median PGA was 50 [40-70] mm vs 50 [30-65] mm VAS respectively (р=0.044).…”

Applying precision medicine to unmet clinical needs in psoriatic disease

“…Digits with dactylitis are also reportedly more likely than those without dactylitis to show radiographic progression (50% versus 38%) [46]. Other predictors of severe peripheral disease in PsA include female sex [45,47], high concentrations of acute-phase proteins at diagnosis or during the disease course [8,48,49], polyarticular disease at presentation [47,50,51,52] and the presence of nail psoriasis [53]. Despite showing promise, these clinical predictors have not been adequately validated and are not considered to be sufficiently discriminatory for use in clinical practice.…”

Interleukin-17 pathway activation inEquus caballussupporting limb laminitis

“…A causal role for IL-17-dependent inflammation in driving psoriasis is highlighted by the success of monoclonal antibody-based therapies that bind IL-17 and block signaling through the IL-17 receptor [18; 21; 23]. Interestingly, a syndrome of psoriasis involving digits and nail beds, termed psoriatic onychodystrophy and psoriatic arthritis/dactylitis, includes lesions such as onycholysis, subungual acanthosis and hyperkeratosis, enthesitis and distal phalangeal osteolysis [24; 25]. Many of the changes listed above for human psoriasis have morphological similarities to equine laminitis and laminitis-associated distal phalangeal osteolysis [11].…”