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Abstract Number: 1370

Clinical and Ultrasonographic Features of Nail Disease in Psoriasis and Psoriatic Arthritis

Amir Haddad1, Arane Thavaneswaran1, Vinod Chandran2 and Dafna D. Gladman3, 1Rheumatology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 2Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 3Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Clinical, Psoriatic arthritis and ultrasound

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Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose: The purpose of this study was to investigate the association between clinical and unltrasonographic features of psoriatic nail disease and to identify specific nail features associated with psoriatic arthritis (PsA).

Methods: Patients with PsA and Psoriasis without arthritis (PsC) were recruited from prospective cohorts in a single centre. Healthy volunteers were also recruited. Subjects with co-existing OA or history of nail trauma were excluded. A detailed nail assessment according to the modified Nail Psoriasis Severity Index (mNAPSI) for the presence of onhycolysis, nail pitting, nail plate crumbling, leukonychia, splinter hemorrhages, nail bed hyperkeratosis and red spots in the lunula was completed for each participant. All participants underwent an ultrasound evaluation of the nail apparatus at each finger with detailed recording of loss of definition of the ventral or dorsal plates, thickness of the nail bed or matrix and the presence of increased vascularity in the nail bed or matrix using a 10-MHz linear array transducer. Doppler signal was standardized with a pulse repetition frequency of 400 Hz, a gain of 20 dB and a low wall filter. Descriptive analyses and comparisons were conducted using Kruskal Wallis for continuous variables and Fisher’s exact test for categorical variables. Logistic regression analyses using GEE model was used to compare between the groups due to repeated observations for each patient. Results: 10 patients were recruited into each group and the results are reported in the following tables:

Table  1-  Demographic Characteristics (n=30) between Controls, PsC and PsA

                                                       Frequency (%) or Mean (sd)

                                              Controls

Controls                                        (n=10)

PsC

(n=10)

PsA

(n=10)

p-value

Gender (Males)

3 (30.0%)

9 (90.0%)

7 (77.8%)

0.02

Age

29.0 (4.4)

46.0 (16.1)

54.7 (12.6)

0.0006

Age at diagnosis of Psoriasis

–

33.0 (21.9)

33.4 (13.8)

0.60

Duration of Psoriasis

–

13.0 (13.9)

21.1 (11.7)

0.10

mNAPSI score

0

6.2 (5.8)

3.8 (4.6)

0.01

Table 2- Summary & Comparison of Fingers Affected by Nail Feature for the three groups

Nail Feature

Controls

PsC

PsA

p-value*

p-value**

Loss of definition of the ventral plate

6/100

24/100

29/100

<0.0001

0.42

Hyperechoioc focal involvement of the ventral plate

0/100

23/100

16/100

<0.0001

0.21

Thickening of both the and dorsal and ventral plates

0/100

8/100

2/100

0.005

0.052

Nail bed thickness (mm)

14.1 (1.2)

16.0 (2.9)

15.9 (3.0)

<0.0001

0.81

Nail matrix thickness (mm)

15.8 (0.92)

17.5 (2.9)

18.8 (3.0)

<0.0001

0.002

Nail bed vascularity

2/100

14/100

18/100

0.001

0.44

Nail matrix vascularity

16/100

30/100

34/100

0.01

0.54

Onycholysis and oil drop dyschromia

(Some vs. none)

0/100

13/100

5/100

0.0005

0.048

Pitting

Some vs. none

0/100

28/100

20/100

<0.0001

0.19

Nail bed crumbling (Some vs. none)

0/100

8/100

0/100

0.0003

0.004

Leukonychia

0/100

3/100

2/100

0.24

0.65

Splinter hemorrhage

0/100

0/100

0/100

NS

NS

Nail bed hyperkeratosis

0/100

0/100

0/100

NS

NS

Red spots in the lunula

0/100

0/100

1/100

0.37

0.32

P-value* is between the 3 groups, p-value** is between the PsC and PsA.

 

None of the nail’s sonographic or clinical covariates were found to statistically different in between PsA and PsC groups after adjusting for repeated measurements. 

Conclusion: This proof of concept study shows that ultrasounds can be used as a tool for assessment of psoriatic nail disease. Patients with psoriatic disease had increased nail bed and matrix thickness as well as vascularity compared to healthy controls. However, whether these microanatomical nail structures could be predictors for evolution of psoriatic arthritis is yet to be determined.  


Disclosure:

A. Haddad,
None;

A. Thavaneswaran,
None;

V. Chandran,

Abbott Canada,

5;

D. D. Gladman,

Abbott Canada,

5.

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