Department of Internal Medicine, Rouen University Hospital, Rouen, France; Institut National de la Santé et de la Recherche Médicale U 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides, Institute for Biochemical Research, Rouen, France.
Department of Internal Medicine, Rouen University Hospital, Rouen, France; Institut National de la Santé et de la Recherche Médicale U 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides, Institute for Biochemical Research, Rouen, France.
J Am Acad Dermatol. 2017 Jun;76(6):1115-1123. doi: 10.1016/j.jaad.2016.11.024. Epub 2016 Dec 20.
Nail involvement has rarely been recognized in systemic sclerosis (SSc). Indeed, only a few small series have assessed nail changes in SSc, most of which are case reports.
The aims of the current case-control study were to: (1) determine the prevalence of fingernail changes in SSc; and (2) evaluate the correlation between fingernail changes and other features of SSc.
In all, 129 patients with SSc and 80 healthy control subjects underwent routine fingernail examination.
The prevalence of fingernail changes was 80.6% in SSc. Patients with SSc more frequently exhibited: trachyonychia (P = .006), scleronychia (P < .0001), thickened nails (P < .0001), brachyonychia (P = .0004), parrot beaking (P < .0001), pterygium inversum unguis (P < .0001), splinter hemorrhages (P < .0001), and cuticle abnormalities (P < .0001) than healthy control subjects. The presence of fingernail changes was associated with digital ulcers (P < .0001), calcinosis cutis (P = .004), and higher values of mean nailfold videocapillaroscopy score (P = .0009).
The cohort originated from a single center.
This study underlines that fingernail changes are correlated with more severe forms of SSc characterized by digital microangiopathy, including digital ulcers and calcinosis cutis. Nail changes should be systematically checked in all patients with SSc, and may be included in the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc.
指甲受累在系统性硬化症（SSc）中很少被认识到。事实上，只有少数几项小型研究评估了 SSc 中的指甲变化，其中大多数是病例报告。
本病例对照研究的目的是：（1）确定 SSc 中指甲变化的患病率；（2）评估指甲变化与 SSc 其他特征之间的相关性。
共有 129 例 SSc 患者和 80 名健康对照者接受了常规指甲检查。
SSc 患者指甲变化的患病率为 80.6%。SSc 患者更常表现出：糙甲（P=0.006）、硬甲（P<0.0001）、指甲增厚（P<0.0001）、短甲（P=0.0004）、鹦鹉嘴甲（P<0.0001）、甲半月倒转（P<0.0001）、裂片形出血（P<0.0001）和甲周结构异常（P<0.0001）。指甲变化的存在与指端溃疡（P<0.0001）、皮肤钙质沉着（P=0.004）和更高的平均甲襞毛细血管镜评分值相关（P=0.0009）。
该队列源自单个中心。
本研究强调指甲变化与以指端微血管病为特征的更严重形式的 SSc 相关，包括指端溃疡和皮肤钙质沉着。应在所有 SSc 患者中系统地检查指甲变化，并且可能被纳入美国风湿病学会/欧洲抗风湿病联盟的 SSc 分类标准。
