Background/Purpose Nail pitting is present in about 10% of healthy adults, and more than 50% of patients with psoriatic arthritis. We believe that the prevalence of spondyloarthritis, especially psoriatic arthritis is higher than published in literature. Most of those patients are undiagnosed or diagnosed with different diseases. Enthesitis is the primary pathology of spondyloarthritis particularly psoriatic arthritis. It was suggested that enthesitis was an autoinflammatory lesion linking nail and joint involvement in psoriatic disease.  Additionally, subclinical enthesopathy was detected more frequently in patients with psoriatic arthritis than those with psoriasis. We hypothesized that individuals with psoriatic nail changes would have a larger magnitude of enthesitis than those with normal nails. To support this hypothesis, we aimed to determine the association between psoriatic nail changes and enthesitis as well as the frequencies of both.

Methods We examined the hand nails of university students for psoriatic nail changes, including pitting, leukonychia, longitudinal and horizontal ridging, pitting, subungal hyperkeratosis, onycholysis, splinter hemorrhages, red spot and oil drop. All students underwent manual palpation of 14 enthesial sites (quadriceps to patella, patella to tibia, Achilles, plantar fascia, medial epicondyle, lateral epicondyle, supraspinatus) that were described in the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Additionally, tenderness of spinous processes of thoracic vertebrae and sacroiliac joints were recorded.

Results Three hundred seventy-seven university students (240 female,  137 male) who are attending to the faculties of medicine (229 students) and  of dentistry (148 students) were included in this study. Two hundred thirty two (61.6%) of 377 students had at least one psoriatic nail change. Less specific nail changes for psoriasis such as leukonychia, horizontal and longitudinal ridging were very common among the university students (Table 1). Pitting was observed in 52 (13.8%) students.  Eighty-eight (23.3%) of 377 participants had at least one tender enthesial point. The most frequently affected  enthesial site was supraspinatus insertion (Table 2).  Students with pitting or any other psoriatic nail changes had a greater number of  tender enthesial points than those with normal nails (p=0.002 and p=0.006, respectively).

Conclusion Pitting was detected more frequently than published in the literature among university students and pitting or any other psoriatic nail changes correlated with tender enthesial points.

Table 1. Psoriatic nail changes in university students
Nail change	N (%)
Leukonychia	136 (36.1)
Horizontal ridging	62 (16.4)
Longitudinal ridging	58 (15.4)
Pitting	52 (13.8)
Subungal hyperkeratosis	19 (5.0)
Onycholysis	18 (4.8)
Splinter hemorrhages	6 (1.6)
Red spot	1 (0.3)
Oil drop	0 (0)

 

Table 2. Frequency of affected enthesial points in university students
Enthesial points	N (%)
Supraspinatus	55 (14.6)
Thoracic vertebrae	27 (7.2)
Sacroiliac joints	20 (5.3)
Lateral epicondyle	20 (5.3)
Medial epicondyle	18 (4.8)
Achilles	12 (3.2)
Quadriceps to patella	10 (2.7)
Patella to tibia	9 (2.4)
Plantar fascia	8 (2.1)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/university-students-with-psoriatic-nail-changes-have-a-greater-number-of-tender-enthesial-points-than-those-with-normal-nails/