Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study

Abstract

Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

Ultrasound clinical references of the healthy toenail unit

“…The only parameter of little use was the distance from the center of the distal phalange to the nail plate, which varied with age, sex, hallux, weight, and nail consistency. This parameter, known as nail bed thickness, was analyzed by other authors, who found ranges of measure lower than those in this study (Cecchini et al, 2009;De Rossi et al, 2021;Idolazzi et al, 2018;Idolazzi et al, 2019;Marina et al, 2016;Mondal et al, 2018;Naredo et al, 2019;Wortsman et al, 2004;Wortsman & Jemec, 2006). However, none of these studies used the toenail unit as a model or made comparisons in healthy participants, and therefore, comparative analysis may not be appropriate.…”

“…De Rossi et al (2021) showed a relation between age and some ultrasound parameters, including nail plate and bed thickness. However, most of the results obtained here do not support this relation, not even concerning nail plate thickness, as the only parameter that varied with age in the present study was the distance from the center of the distal phalange to the nail plate.…”

“…The literature includes studies on ultrasound parameters of the nail, in all cases in the fingernail unit (Bellinato et al, 2022; Cecchini et al, 2009; De Rossi et al, 2021; Idolazzi et al, 2018; Idolazzi et al, 2019; Mondal et al, 2018; Naredo et al, 2019; Wollina et al, 2001; Wortsman et al, 2004). Only two of these studies (Bellinato et al, 2022; Cecchini et al, 2009) were performed on healthy participants.…”

Comprehensive assessment of the dynamics of angiogenesis in patients with psoriasis treated with methotrexate

“…В целом ряде ранее опубликованных исследований было показано, что под влиянием системной терапии псориаза ацитретином, циклоспорином, адалимумабом и этанарцептом происходит уменьшение плотности и размеров сосудистых клубочков и снижение уровня допплеровского кровотока в коже и ногтях больных псориазом, также продемонстрировано влияние системной терапии на плазменные концентрации VEGF [6,12,13,[16][17][18][19][20][21][22][23]. Следует отметить, что большинство из этих работ выполнены на небольшой выборке больных, в них использовался только один из методов визуализации ангиогенеза кожи (либо видеодерматоскопия, либо ультразвуковая допплерография).…”

“…Позитивной особенностью применения энергетического ультразвукового допплеровского исследования является возможность визуализации артериальных сосудов ногтевого ложа [19,20]. В ряде работ у больных псориазом продемонстрированы повышение количества допплеровских сигналов в слое дермы в области псориатической бляшки и ногтевом ложе при псориатическом поражении ногтей, изменения характера кровотока в артериях ногтевого ложа с повышением индекса резистивности [21][22][23].…”