Centre for Rheumatology Research, Landspitali Haskolasjukrahus, Fossvogi, 108 Reykjavik, Iceland.
J Rheumatol. 2012 Jul;39(7):1441-4. doi: 10.3899/jrheum.111298. Epub 2012 May 15.
To measure the associations between subtypes of nail changes and psoriatic arthritis (PsA) among patients with psoriasis.
Patients age 18 years and older with active psoriasis were examined for skin and nail changes and asked if they had been diagnosed with PsA. Patients with arthritis were invited for a separate study 1-6 years after their initial visit. Univariate and multivariate analyses were used to test the strength of associations between subtypes of nail changes and arthritis.
Of 1116 patients with psoriasis, 37% (95% CI 34%-40%) had nail changes. Age, any nail change, onycholysis, and pitting were each associated with PsA on univariate analysis. Multivariate analysis showed that onycholysis was the only type of nail change independently associated with PsA (OR 2.05, p < 0.001). Nail changes persisted and had increased in prevalence at the followup examination at a mean of 3.8 (median 4 yrs, interquartile range 3-4) years later. Previously reported associations between psoriasis location and arthritis were not seen in this dataset.
PsA is associated with onycholysis. Associations with pitting and subungual hyperkeratosis were not statistically significant. Subtypes of nail changes should be analyzed separately in future studies of PsA.
测量银屑病患者的指甲变化亚型与银屑病关节炎（PsA）之间的关联。
对年龄在 18 岁及以上且患有活动性银屑病的患者进行皮肤和指甲变化检查，并询问他们是否被诊断患有 PsA。在初次就诊后 1 至 6 年内，有关节炎的患者会被邀请参加单独的研究。使用单变量和多变量分析来测试指甲变化亚型与关节炎之间关联的强度。
在 1116 名银屑病患者中，37%（95%CI 34%-40%）有指甲变化。在单变量分析中，年龄、任何指甲变化、甲分离和凹点均与 PsA 相关。多变量分析显示，甲分离是唯一与 PsA 独立相关的指甲变化类型（OR 2.05，p<0.001）。指甲变化在平均 3.8（中位数 4 年，四分位距 3-4）年后的随访检查中持续存在且患病率增加。在这个数据集没有发现以前报道的银屑病位置与关节炎之间的关联。
PsA 与甲分离有关。与凹点和甲下过度角化的关联没有统计学意义。在未来的 PsA 研究中，应单独分析指甲变化的亚型。
