Klaassen Karlijn M G, Ploegmakers Marieke J M, van de Kerkhof Peter C M, Klein Willemijn M, Pasch Marcel C
Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Dtsch Dermatol Ges. 2017 Apr;15(4):405-412. doi: 10.1111/ddg.13222.
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.
甲银屑病患者银屑病关节炎的患病率较高；然而，这两种疾病之间的发病机制关系尚不清楚。附着点被认为是疾病的中心，这可能在解剖学层面解释发病机制。
以远端指间关节的伸肌附着点为中心，为阐明甲银屑病与银屑病关节炎之间的解剖学联系这一假说提供依据。
我们进行了一项横断面队列研究，使用三维超声对指甲银屑病患者（n = 54）、无甲受累的银屑病患者（n = 32）和健康对照者（n = 32）的远端指间（DIP）关节附着点进行成像。指甲银屑病患者在一年后接受重复成像研究。
指甲银屑病患者的桡侧附着点明显比无甲受累的银屑病患者厚。然而，受累指甲与未受累指甲之间的附着点厚度无显著差异（1.297毫米对1.253毫米，p = 0.13）。一年后的随访显示，附着点厚度与指甲银屑病活动度之间无显著差异。
本研究为指甲银屑病患者远端指间关节水平的亚临床附着点炎提供了证据。然而，无法证实甲银屑病与银屑病关节炎之间存在解剖学关联。
