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Abstract Number: 1718

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?

M Laura Acosta-Felquer1, Erika Catay2, Leandro Ferreyra-Garrot3, Santiago Ruta1, David A. Navarta4, Javier Rosa5, Ricardo Galimberti6, Maria L. Galimberti6, Ricardo Garcia-Monaco7 and Enrique R. Soriano8, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio,, Buenos Aires, Argentina, 3Rheumatology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Internal Medicine, Argentina, Buenos Aires, Argentina, 4Internal Medicine, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 5Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 6Dermatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 7Radiology and Imagenology Department, Hospital italiano de Buenos Aires, Buenos Aires, Argentina, 8Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Enthesitis, Enthesopathy, psoriasis, Psoriatic arthritis and ultrasound

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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.


Disclosure: M. L. Acosta-Felquer, None; E. Catay, None; L. Ferreyra-Garrot, None; S. Ruta, None; D. A. Navarta, None; J. Rosa, None; R. Galimberti, None; M. L. Galimberti, None; R. Garcia-Monaco, None; E. R. Soriano, Abbvie; Janssen; UCB; Roche; Bristol Myers Squibb, 2,Abbvie; UCB; Janssen; Roche; Bristol Myers Squibb; Pfizer; Novartis, 8.

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 .
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