The ultrasonographic study of the nail reveals differences in patients affected by inflammatory and degenerative conditions
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Introduction and objectives
The nail unit is a subject of interest in several diseases, often involving different medical fields. Even if few data are available for psoriasis and psoriatic arthritis, no data regarding ultrasonography and imaging are present for other degenerative and inflammatory conditions. The aim of this study was to explore through imaging the changes of nail and enthesis in inflammatory and degenerative conditions in order to find qualitative and quantitative changes related to distal interphalangeal joints.
The study sample was composed of 51 patients affected by psoriatic arthritis, 31 affected by psoriasis, 37 subjects with rheumatoid arthritis, 34 with osteoarthritis and 50 healthy controls for a total of 203 individuals. Ultrasonography of the nails was performed after clinical evaluation in a cross-sectional study design by blinded ultrasonographers who were blind to patient data. Data about power Doppler signal of the nail bed, tendon entheses, thickness of nail plate and nail bed were recorded.
Patients affected by psoriasis and psoriatic arthritis differ from other subgroups, and power Doppler signal at the enthesis seems to be an exclusive feature of psoriatic arthritis (Pearson’s chi-square of 5297 and p < 0.001 with adjusted residuals). Nail plate thickness also differs in psoriasis and psoriatic arthritis, but surprisingly in osteoarthritis, too, with similar results.
This study provides qualitative and quantitative data regarding the ultrasonographic features of nails in several rheumatic diseases with a potential role of ultrasonography in characterising them.
KeywordsNail bed Nail plate Psoriasis Psoriatic arthritis Ultrasonography
Compliance with ethical standards
All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Declaration of Helsinki of 1975, as revised in 1983.
- 2.Errichetti E, Zabotti A, Stinco G, Quartuccio L, Sacco S, de Marchi G, Piccirillo A, de Vita S (2016) Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis. J Dermatol 43:1217–1220. https://doi.org/10.1111/1346-8138.13438 CrossRefGoogle Scholar
- 4.Zabotti A, Errichetti E, Zuliani F, Quartuccio L, Sacco S, Stinco G, de Vita S (2018) Early psoriatic arthritis versus early seronegative rheumatoid arthritis: role of dermoscopy combined with ultrasonography for differential diagnosis. J Rheumatol 45:648–654. https://doi.org/10.3899/jrheum.170962 CrossRefGoogle Scholar
- 5.Tan AL, Tanner SF, Waller ML, Hensor EMA, Burns A, Jeavons AP, Bury RF, Emery P, McGonagle D (2013) High-resolution [18F]fluoride positron emission tomography of the distal interphalangeal joint in psoriatic arthritis–a bone-enthesis-nail complex. Rheumatology (Oxford) 52:898–904. https://doi.org/10.1093/rheumatology/kes384 CrossRefGoogle Scholar
- 6.Scarpa R, Cuocolo A, Peluso R, Atteno M, Gisonni P, Iervolino S, di Minno MN, Nicolai E, Salvatore M, del Puente A (2008) Early psoriatic arthritis: the clinical spectrum. J Rheumatol 35:137–141Google Scholar
- 7.Yang Q, Qu L, Tian H, Hu Y, Peng J, Yu X, Yu C, Pei Z, Wang G, Shi B, Zhang F, Zhang Y, Zhang F (2011) Prevalence and characteristics of psoriatic arthritis in Chinese patients with psoriasis. J Eur Acad Dermatol Venereol 25:1409–1414. https://doi.org/10.1111/j.1468-3083.2011.03985.x CrossRefGoogle Scholar
- 16.Zabotti A, Bandinelli F, Batticciotto A, Scirè CA, Iagnocco A, Sakellariou G, on behalf of the Musculoskeletal Ultrasound Study Group of the Italian Society of Rheumatology (2017) Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 56:1518–1532. https://doi.org/10.1093/rheumatology/kex179 CrossRefGoogle Scholar
- 17.Aydin SZ, Ash ZR, Tinazzi I, Castillo-Gallego C, Kwok C, Wilson C, Goodfield M, Gisondi P, Tan AL, Marzo-Ortega H, Emery P, Wakefield RJ, McGonagle DG (2013) The link between enthesitis and arthritis in psoriatic arthritis: a switch to a vascular phenotype at insertions may play a role in arthritis development. Ann Rheum Dis 72:992–995. https://doi.org/10.1136/annrheumdis-2012-201617 CrossRefGoogle Scholar
- 20.Acosta Felquer ML, FitzGerald O (2015) Peripheral joint involvement in psoriatic arthritis patients. Clin Exp Rheumatol 33:S26–S30Google Scholar
- 22.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581. https://doi.org/10.1002/art.27584 CrossRefGoogle Scholar
- 25.Idolazzi L, Gisondi P, Fassio A, Viapiana O, Giollo A, Rossini M, Girolomoni G, Gatti D (2018) Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis. Med Ultrason 20:177–184. https://doi.org/10.11152/mu-1327 CrossRefGoogle Scholar
- 26.D’Agostino M-A, Wakefield RJ, Berner-Hammer H et al (2016) Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study. Ann Rheum Dis 75:1763–1769. https://doi.org/10.1136/annrheumdis-2015-207709 CrossRefGoogle Scholar
- 27.Watad A, Eshed I, McGonagle D (2017) Lessons learned from imaging on enthesitis in psoriatic arthritis. Isr Med Assoc J 19:708–711Google Scholar
- 35.Acosta-Felquer ML, Ruta S, Rosa J, Marin J, Ferreyra-Garrot L, Galimberti ML, Galimberti R, Garcia-Monaco R, Soriano ER (2017) Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory. Semin Arthritis Rheum 47:338–342. https://doi.org/10.1016/j.semarthrit.2017.05.002 CrossRefGoogle Scholar