The relationship between the nail and systemic enthesitis in psoriatic arthritis

Elliott, Ashley; Pendleton, Adrian; Wright, Gary; Rooney, Madeleine

doi:10.1093/rap/rkab088

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…Furthermore, this subclinical nail involvement could reinforce the concept of psoriatic disease continuum, ranging from skin involvement to the musculoskeletal manifestations [ 34 ]. According to the nail-entheseal pathogenesis proposed in psoriatic disease [ 1 , 9 , 35 ], the nail lesions are frequently associated with the presence of enthesis involvement suggesting the relevance of their evaluation in managing these patients [ 36 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study

et al. 2022

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Purpose To characterize nail and enthesis abnormalities using high frequency ultrasound (HFUS) in patients with psoriasis (PSO), psoriatic arthritis (PSA) with PSO, and PSA sine PSO. Material and Methods Patients with PSO, PSA with PSO, and PSA sine PSO were evaluated and compared in a cross-sectional single centre study. Nail and enthesis abnormalities were evaluated by HFUS using high frequency probes (27 MHz). After a descriptive assessment, Brown University Nail Enthesis Scale (BUNES) and Madrid Sonography Enthesitis Index (MASEI) were used to assess nail and enthesis, respectively. Results Fifty-nine patients were enrolled (19 PSO, 22 PSA with PSO, 18 PSA sine PSO). In patients with PSO and in those with PSA and PSO, HFUS evaluation identified the following nail alterations characterised by thickened matrix, inhomogeneous echogenicity of the nail bed, and increased blood flow by power Doppler. In 38.9% patients with PSA sine PSO, a subclinical nail involvement was described. No difference was observed comparing BUNES values in three groups. In PSA patients with PSO and in those with PSA sine PSO, HFUS assessment of entheses mainly showed a hypoechoic aspect and thickness of the tendon, focal cortical erosion, and ossification. A subclinical enthesis involvement in 47.4% patients with PSO was observed. No difference was reported comparing MASEI values in three groups. Conclusion Qualitative and quantitative abnormalities of nail and enthesis were demonstrated by HFUS in patients with PSO, PSA with PSO, and PSA sine PSO, suggesting a practical additional tool to be used in clinical settings. Furthermore, HFUS highlighted a subclinical nail involvement in patients with PSA sine PSO and enthesis subclinical alterations in patients with PSO.

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Section: Discussionmentioning

confidence: 99%

Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study

et al. 2022

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“…This is to our knowledge the first paper that has assessed a change in ultrasound-confirmed enthesitis in PsA between different classes of biologic therapies. 17 Ultimately, we have seen an overall decrease in ultrasound confirmed entheseal disease for both classes of biologic therapy. In terms of comparing ultrasound response for the treatments administered, there was a larger Other studies have demonstrated a weak correlation between the MASEI and the clinical LEI scores 18 but interestingly that research group when only assessing the clinical sites of the MASEI did not see a correlation with ultrasound MASEI scores.…”

Section: Discussionmentioning

confidence: 76%

Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis

Elliott,

Wright,

Pendleton

et al. 2023

Therapeutic Advances in Musculoskeletal

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Introduction: Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions. Methods: This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI). Results: In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab n = 23 and tumour necrosis factor inhibitor (TNFi) n = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi versus 1.74 with secukinumab ( p = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi versus secukinumab (4.37 versus 2.26; p = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 versus 2.00; p = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab versus TNFi. Conclusions: We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi versus secukinumab that merits further exploration.

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Association of enthesitis with severity of psoriasis in psoriatic arthritis: an observational study

Grazio,

Šitum,

Grubišić

et al. 2024

Rheumatol Int

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The relationship between the nail and systemic enthesitis in psoriatic arthritis

Cited by 6 publications

References 14 publications

Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study

Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study

Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis

Association of enthesitis with severity of psoriasis in psoriatic arthritis: an observational study

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