Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
It has been shown that nail involvement in psoriasis is associated with systemic enthesopathy. The association of enthesopathy and nail disease at distal interphalangeal (DIP) joints in psoriasis (PsO) and psoriatic arthritis (PsA) has not been studied until now. Our purpose was to analyze the association of nail involvement and extensor tendon enthesopathy at DIP level in patients with PsO and PsA.
Methods:
Consecutive patients with PsO or PsA were included. Patients with DIP osteoarthrtitis were excluded. Patients were seen by trained rheumatologists and dermatologists, for diagnosis and the Psoriasis Area and Severity Index (PASI), and the modify Nail Psoriasis Severity Index (mNAPSI) were calculated. Ultrasound (US) examinations included the second to fourth extensor tendon insertions at DIP joints bilaterally. The Outcome Measures in Rheumatoid Arthritis (OMERACT) definition of enthesopathy was adopted. Prevalence with 95% confidence intervals of enthesopathy was calculated for PsO and PsA with and without nail involvement and compared. The relationship between nail involvement and enthesopathy was also analyzed at fingers level.
Results:
One hundred and ten patients were included (table 1). US showed extensor tendon enthesopathy (ETE) in at least one DIP joint in 9 patients with PsO (17%; 95% CI: 8-29 %) and in 18 with PsA (32 %; 95%CI: 20-46%) (p=0.059). Among patients with PsO, 20% (95%CI: 7-41%) and 14% (95% CI:4-32%) of those with and without clinical nail involvement showed ETE on US examination, respectively (p=0.542). Among PsA patients, the prevalence of ETE was 30% (95% CI: 15-49%) for patients with clinical nail involvement and 35 % (95% CI: 17-56%) for those without nail involvement, respectively (p=0.712). On logistic regression analysis, the diagnosis of PsA (OR: 3.3; 95% CI: 1.1-9.8; p=0.032), but not nail involvement (OR: 1.1 (95% CI: 0.42-3); p=0.824 was associated with ETE, while the use of DMARDs was protective (OR: 0.33; 95% CI: 0.11-0.99; p=0.0481). Table 2 shows the relationship between ETE and clinical nail involvement at fingers level.
Table 1. Patients’ characteristics
|
Features |
PsO (n= 54) |
PsA (n=56) |
|
Females, n (%) |
26 (53) |
28 (46) |
|
Mean disease duration, yrs (SD) |
10.4 (8) |
4.9 (6) |
|
Nail involvement, n (%) |
25 (46.3) |
30 (54) |
|
Mean PASI (SD) |
4.3 (5) |
3.4 (5.4) |
|
Mean mNAPSI (SD) |
6.7 (10.4) |
9.3 (12.4) |
|
Treated with DMARDs, n (%) |
14 (26) |
39 (70) |
|
Treated with TNFi, n (%) |
3 (6) |
12 (21) |
Table 2. Association between extensor tendon enthesopathy and nail involvment at fingers level
|
Psoriasis Patients (n=54) |
Psoriatic Arthritis Patients (n=56) |
All Patients (n=110) |
||||
|
Nails with clinical involvement (n= 93) |
Normal nails (n=339) |
Nails with clinical involvement (n=143) |
Normal nails (n=305) |
Nails with clinical involvement (n=236) |
Normal Nails (n=644) |
|
|
Number of fingers with Extensor tendon enthesopathy (%) |
57 (61) |
57 (17) |
86 (60) |
67 (22) |
143 (60) |
124 (19) |
|
OR (95% CI) |
7.8 (4.6-13.4) p<0.0001 |
5.4 (3.4-8.4) p<0.0001 |
6.5 (4.6-9.1) P<0.0001 |
|||
Conclusion: Extensor tendon enthesopathy at DIP joints was more frequent in PsA than in PsO. No association was found between nail involvement and extensor tendon enthesopathy at patients’ level. There was a significant increased prevalence of extensor tendon enthesopathy in fingers with involved nails both in PsO and PsA. These features might support the nail-entheseal pathogenesis theory at DIP level.
To cite this abstract in AMA style:
Acosta-Felquer ML, Catay E, Ferreyra-Garrot L, Ruta S, Navarta DA, Rosa J, Galimberti R, Galimberti ML, Garcia-Monaco R, Soriano ER. Entheseal Abnormalities and Nail Involvement at the Distal Interphalangeal Joints on Ultrasound Examination in Patients with Psoriasis and Psoriatic Arthritis. Could the Nail-Enthesitis Theory be Supported? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/entheseal-abnormalities-and-nail-involvement-at-the-distal-interphalangeal-joints-on-ultrasound-examination-in-patients-with-psoriasis-and-psoriatic-arthritis-could-the-nail-enthesitis-theory-be-supp/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/entheseal-abnormalities-and-nail-involvement-at-the-distal-interphalangeal-joints-on-ultrasound-examination-in-patients-with-psoriasis-and-psoriatic-arthritis-could-the-nail-enthesitis-theory-be-supp/