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Rheumatology International

, Volume 39, Issue 4, pp 697–705 | Cite as

To what extend is nail ultrasound discriminative between psoriasis, psoriatic arthritis and healthy subjects?

  • Esperanza NaredoEmail author
  • Iustina Janta
  • Ofelia Baniandrés-Rodríguez
  • Lara Valor
  • Michelle Hinojosa
  • Natalia Bello
  • Belén Serrano
  • Jesús Garrido
Imaging
  • 113 Downloads

Abstract

To assess the discriminative utility of nail features detected by B-mode (BM) and color Doppler (CD) ultrasound (US) between patients with psoriasis (PsO) and psoriatic arthritis (PsA) and healthy controls. Sixty patients with PsA, 21 patients with PsO, and 20 healthy controls were prospectively included. All patients underwent a dermatologic assessment and PsA patients also a rheumatologic assessment. All patients and controls underwent a US assessment of the finger nails that included a BM score for nail plate integrity and four different CD scores based on the amount and location of CD signals in the nail bed/matrix. In addition, we measured the thickness of the nail bed (TNB) and nail plate (TNP). The BM score and the CD score based on the amount of signals in the nail bed in contact with the ventral plate discriminated between the control group (median, range 0.0, 0–4 and 2.0, 0–9, respectively) and the PsO/PsA group (median, range: 7.0, 0–31 and 5.14, 0–13, respectively) (p < 0.05) with or without clinical nail involvement. The CD scores based on the percentage of the nail bed/matrix occupied by Doppler signals did not discriminate between controls and PsO/PsA patients. TNB and TNP were significantly higher in psoriatic nails with or without clinical involvement than in control nails. In PsO/PsA patients, the BM score, TNB and TNP were significantly higher in clinically involved nail than in clinically non-involved nails. Our results showed discriminative utility of BM US and some CD US features for PsO/PsA nails.

Keywords

Ultrasound Nail Psoriasis Psoriatic arthritis Doppler 

Notes

Author contributions

Study design: EN. Acquisition of data: IJ, OBR, LV, MH, NB, BS, and EN. Analysis and interpretation of data: EN and JG. Manuscript drafting: EN, IJ, and JG. Manuscript revision and approval: IJ, OBR, LV, MH, NB, BS, JG, and EN.

Funding

This work was supported by UCB Pharma through a publication Grant, and underwent courtesy review by UCB Pharma.

Compliance with ethical standards

Conflict of interest

Esperanza Naredo, Iustina Janta, Ofelia Baniandres-Rodriguez, Lara Valor, Michelle Hinojosa, Natalia Bello, Belén Serrano, and Jesús Garrido declare that they have no conflict of interest relating to the topic.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

296_2018_4222_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 KB)
296_2018_4222_MOESM2_ESM.jpg (17 kb)
Supplementary Fig 1. B-mode score, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Normal aspect of the dorsal and ventral palates (BM-Sc=0). b). Involvement of the ventral plate only at the matrix level (BM-Sc=1). c). Involvement of the whole ventral plate (BM-Sc=2). d). Involvement of the both plates (BM-Sc=3). e). Complete loss of the normal structure (BM-Sc=4). (JPG 16 KB)
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Supplementary material 3 (JPG 16 KB)
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Supplementary material 4 (JPG 19 KB)
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Supplementary material 5 (JPG 15 KB)
296_2018_4222_MOESM6_ESM.jpg (16 kb)
Supplementary Fig 1. B-mode score, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Normal aspect of the dorsal and ventral palates (BM-Sc=0). b). Involvement of the ventral plate only at the matrix level (BM-Sc=1). c). Involvement of the whole ventral plate (BM-Sc=2). d). Involvement of the both plates (BM-Sc=3). e). Complete loss of the normal structure (BM-Sc=4). (JPG 16 KB)
296_2018_4222_MOESM7_ESM.jpg (12 kb)
Supplementary Fig 2. CD score 1, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Isolated Doppler spots (CD-Sc1=0). b). Doppler signals occupying less than 50% of the nail matrix/bed area (CD-Sc1=1). c). Doppler signals occupying more than 50% of the nail matrix/bed area (CD-Sc1=2) (JPG 11 KB)
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Supplementary material 7 (JPG 19 KB)
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Supplementary material 8 (JPG 23 KB)
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Supplementary Fig 3. CD score 2, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Doppler signals without contact with the ventral plate (CD-Sc2=0). b). Doppler signals with isolated focal contact with the ventral plate (CD-Sc2=1). c). Doppler signals with diffuse contact with the ventral plate (CD-Sc2=2). (JPG 20 KB)
296_2018_4222_MOESM11_ESM.jpg (17 kb)
Supplementary material 10 (JPG 16 KB)
296_2018_4222_MOESM12_ESM.bmp (173 kb)
Supplementary material 11 (BMP 172 KB)

References

  1. 1.
    Langley RG, Krueger GG, Griffiths CE (2005) Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 64(Suppl 2):ii18–i23PubMedGoogle Scholar
  2. 2.
    Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(Suppl 2):ii14–i7PubMedGoogle Scholar
  3. 3.
    Sánchez-Regaña M. Umbert P (2008) Diagnosis and management of nail psoriasis. Actas Dermosifiliogr 99:34–43CrossRefPubMedGoogle Scholar
  4. 4.
    Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (2009) Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 61:233–239CrossRefPubMedGoogle Scholar
  5. 5.
    Rich P, Scher RK (2003) Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol 49:206–212CrossRefPubMedGoogle Scholar
  6. 6.
    Cassell SE, Bieber JD, Rich P, Tutuncu ZN, Lee SJ, Kalunian KC, Wu CW, Kavanaugh A (2007) The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis. J Rheumatol 34:123–129PubMedGoogle Scholar
  7. 7.
    Østergaard M, Eder L, Christiansen SN, Kaeley GS (2016) Imaging in the diagnosis and management of peripheral psoriatic arthritis-The clinical utility of magnetic resonance imaging and ultrasonography. Best Pract Res Clin Rheumatol 30:624–637CrossRefPubMedGoogle Scholar
  8. 8.
    Wortsman X, Jemec GB (2006) Ultrasound Imaging of nails. Dermatol Clin 24:323–328CrossRefPubMedGoogle Scholar
  9. 9.
    Gutierrez M, Wortsman X, Filippucci E, De Angelis R, Filosa G, Grassi W (2009) High-frequency sonography in the evaluation of psoriasis nail and skin involvement. Ultrasound Med 28:1569–1574CrossRefGoogle Scholar
  10. 10.
    Gutierrez M, Filippucci E, De Angelis R, Filosa G, Kane D, Grassi W (2010) A sonographic spectrum of psoriatic arthritis: “the five targets”. Clin Rheumatol 29:133–142CrossRefPubMedGoogle Scholar
  11. 11.
    Aydin SZ, Castillo-Gallego C, Ash ZR, Marzo-Ortega H, Emery P, Wakefield RJ, Wittmann M, McGonagle D (2012) Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy. Dermatology 225:231–235CrossRefPubMedGoogle Scholar
  12. 12.
    Gisondi P, Idolazzi L, Girolomoni G (2012) Ultrasonography reveals nail thickening in patients with chronic plaque psoriasis. Arch Dermatol Res 304:727–732CrossRefPubMedGoogle Scholar
  13. 13.
    Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, Filippucci E, Grassi W (2012) Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology 51:1261–1268CrossRefPubMedGoogle Scholar
  14. 14.
    Sandobal C, Carbó E, Iribas J, Roverano S, Paira S (2014) Ultrasound Nail Imaging on Patients With Psoriasis and Psoriatic Arthritis Compared With Rheumatoid Arthritis and Control Subjects. J Clin Rheumatol 20:21–24CrossRefPubMedGoogle Scholar
  15. 15.
    Arbault A, Devilliers H, Laroche D, Cayot A, Vabres P, Maillefert JF, Ornetti P (2016) Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis. Joint Bone Spine 83:539–544CrossRefPubMedGoogle Scholar
  16. 16.
    Marina ME, Solomon C, Bolboaca SD, Bocsa C, Mihu CM, Tătaru AD (2016) High-frequency sonography in the evaluation of nail psoriasis. Med Ultrason 18:312–317CrossRefPubMedGoogle Scholar
  17. 17.
    Aydin SZ, Castillo-Gallego C, Ash ZR, Marzo-Ortega H, Wakefield R, McGonagle D (2017) Vascularity of nail bed by ultrasound to discriminate psoriasis, psoriatic arthritis and healthy controls. Clin Exp Rheumatol 35:872PubMedGoogle Scholar
  18. 18.
    Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673CrossRefPubMedGoogle Scholar
  19. 19.
    Langley RG, Ellis CN (2004) Evaluating psoriasis with psoriasis area and severity index, psoriasis global assessment, and lattice system physician’s global assessment. J Am Acad Dermatol 51:563–569CrossRefPubMedGoogle Scholar
  20. 20.
    Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, Landewé R, van ver Tempel H, Mielants H, Dougados M, van der Heijde D (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62:127–132CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez DíazIIS Fundación Jiménez Díaz, and Universidad Autónoma de MadridMadridSpain
  2. 2.Department of RheumatologyHospital General Universitario Gregorio MarañónMadridSpain
  3. 3.Department of DermatologyHospital General Universitario Gregorio MarañónMadridSpain
  4. 4.Rheumatology and Clinical Immunology DepartmentUniversitätsklinikum Erlangen-NürnbergErlangenGermany
  5. 5.Department of Internal Medicine and RheumatologyHospital Helios Klinikum Berlin-BuchBerlinGermany
  6. 6.Department of Social Psychology and Methodology, Facultad de PsicologíaUniversidad Autónoma de MadridMadridSpain

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