Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Nail disease represents a very important symptom in subjects with psoriasis and psoriatic arthritis (PsA). From a dermatologic perspective, onychopathy is a predictor for the development of arthritis while, for rheumatologist, it is associated with distal interphalangeal joint arthritis. Besides, it is included in the CASPAR classification criteria for PsA. Psoriatic onychopathy has recently become a new hot topic for ultrasound (US) in rheumatology and a few authors have illustrated the most important findings. Nowadays, one of the main problems for dermatologists is the differential diagnosis between psoriatic onychopathy and onychomycosis or, in general, infective disease of the nail.
The aim of the study is to find possible differences in the US findings between onychopathy due to psoriasis and mycosis.
Methods: A group of patients referring to the Dermatology unit of our hospital, presenting onychopathy, was examined by US (Logiq9, General Electrics, USA), using a multi-frequency linear probe operating at 15 MHz. The nail to be assessed was decided by the dermatologist who also requested cultural examination when onychomycosis was suspected. The US examination, made by a rheumatologist who is well experienced in US and unaware of the diagnosis of the patient, was performed according to what was shown by Gutierrez et al (1). We also used the group of patients without an established diagnosis as self-controls, scanning at least one other nail apparently without any visible onychopathy. The final diagnosis was given by the dermatologist based on the results of the clinical examination and the laboratory test.
Results: 15 patients were studied (10 with an established diagnosis of psoriasis and 5 with a final diagnosis of mycosis). The results of the US examination are reported in Table I.
Conclusion:
As shown in the table, none of the patients with mycosis presented a change in the trilaminare pattern of the nail, which was thickened with respect to both the psoriasis and the “healthy” nail group. Both the mycosis and psoriasis group showed an increase of power Doppler signal with respect to the “healthy” control group. The striking difference between US findings in patients with psoriasis and mycosis could suggest that US examination of the nail might be an easy and rapid way to differentiate between nail involvement in psoriasis and mycosis.
Tab. I
|
Diagnosis (N of nails) |
US findings |
|||
|
Conserved 3 lines appearance (yes/no) |
Nail thickness (mm) |
Nail matrix thickness (mm) |
Power Doppler score (yes/no; mean value 0-3) |
|
|
Psoriasis (N=20) |
11/9 |
0.56±0.13 |
2.11±0.20 |
15/5 (0.95) |
|
Mycosis (N=8) |
8/0 |
0.82±0.19 |
3.65±1.39 |
4/8 (0.625) |
|
Controls (N=8) |
8/0 |
0.65±0.26 |
2.42±1.36 |
1/5 (0.20) |
Disclosure:
A. Delle Sedie,
None;
V. Dini,
None;
L. Carli,
None;
S. Barbanera,
None;
L. Riente,
None;
S. Bombardieri,
None;
M. Romanelli,
None.
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