Detection of subclinical ultrasound enthesopathy and nail disease in patients at risk of psoriatic arthritis.

To detect subclinical entheses and nail abnormalities using gray-scale (GS) and power Doppler ultrasonography (PDUS) between patients with nail psoriasis and those with inverse and scalp psoriasis. In this prospective monocentric study, patients with nail, inverse and scalp psoriasis, without psoriatic arthritis or systemic treatment, were included. Clinical evaluation and ultrasonographic assessment of 14 entheses and 12 nails were done by a dermatologist (clinical assessment) and a rheumatologist (ultrasonographic assessment). 518 entheses were analyzed, with no statistical difference between the two groups when considering GS enthesopathy (P=0.66). PDUS signal of the entheses were low (<1%) in both groups. Matrix thickness was significantly higher in patients with nail disease (1.94mm vs. 1.77mm; P=0.007). PDUS of the skin thickness at the level of distal joint and the loss of the trilaminar appearance were also significantly associated with nail psoriasis (P=0.037 and P<0.0001 respectively). Detection of subclinical US enthesopathy is not so rare in both groups, unlike PD signal, but with no statistical difference. US are a good tool to evaluate the different components of psoriatic nails (loss of trilaminar appearance, nail thickening and inflammation of the skin thickness) which are significantly associated with nail psoriasis.

Acquitter M ，Misery L ，Saraux A ，Bressollette L ，Jousse-Joulin S ... -  《-》

Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease.

Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered. To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA. Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand. Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368). Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

Moya Alvarado P ，Roé Crespo E ，Muñoz-Garza FZ ，López-Ferrer A ，Laiz Alonso A ，Vilarrassa Rull E ，Casademont I Pou J ，Puig Sanz L ... -  《-》

Nail Enthesis Ultrasound in Psoriasis and Psoriatic Arthritis: A Report from the 2016 GRAPPA Annual Meeting.

Cunha JS ，Qureshi AA ，Reginato AM 《-》

High prevalence of ultrasonographic synovitis and enthesopathy in patients with psoriasis without psoriatic arthritis: a prospective case-control study.

Naredo E ，Möller I ，de Miguel E ，Batlle-Gualda E ，Acebes C ，Brito E ，Mayordomo L ，Moragues C ，Uson J ，de Agustín JJ ，Martínez A ，Rejón E ，Rodriguez A ，Daudén E ，Ultrasound School of the Spanish Society of Rheumatology and Spanish ECO-APs Group ... -  《-》

Subclinical enthesitis in nail psoriasis patients: a case-control study.

Patients with nail psoriasis have a higher prevalence of psoriatic arthritis; however, the pathogenetic relationship between these two disorders is as yet unclear. Entheses have been suggested as disease epicenter, which might explain the pathogenesis on an anatomical level. To contribute to the elucidation of the hypothesis as regards the anatomical link between nail psoriasis and psoriatic arthritis, with the extensor enthesis of the distal interphalangeal joint as the epicenter. We conducted a cross-sectional cohort study, visualizing the distal interphalangeal (DIP) joints entheses of patients with fingernail psoriasis (n = 54), psoriasis patients without nail involvement (n = 32), and healthy controls (n = 32) using three-dimensional ultrasound. Patients with nail psoriasis underwent repeat imaging studies after one year. Individuals with nail psoriasis had significantly thicker radial entheses than psoriasis patients without nail involvement. However, there were no significant differences in entheseal thickness between adjacent nails that were affected and those that were not (1.297 mm vs. 1.253 mm, p = 0.13). Follow-up after one year showed no significant differences in entheseal thickness in correlation with nail psoriasis activity. The present study provides evidence for subclinical enthesitis at the level of the DIP joint in patients with nail psoriasis. However, an anatomical correlation between nail psoriasis and psoriatic arthritis could not be confirmed.

Klaassen KM ，Ploegmakers MJ ，van de Kerkhof PC ，Klein WM ，Pasch MC ... -  《-》