Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Semin Arthritis Rheum. 2017 Dec;47(3):338-342. doi: 10.1016/j.semarthrit.2017.05.002. Epub 2017 May 11.
It has been shown that nail involvement in psoriasis is associated with systemic enthesopathy. Our objective was to evaluate the association of nail involvement and enthesopathy at distal interphalangeal joint (DIP) level in psoriasis (PsO) and psoriatic arthritis (PsA) patients.
Consecutive patients (54 PsO and 56 PsA) seen at the outpatients clinic in this cross-sectional study were included. All patients underwent both clinical and ultrasound (US) assessment on the same day.
US revealed enthesopathy in at least 1 DIP joint in 9 patients with PsO (17%, 95% CI: 8-29%) and in 18 patients with PsA (32%, 95% CI: 20-46%). US extensor tendon enthesopathy was detected in a higher proportion of fingers with clinical nail involvement compared with fingers without clinical nail involvement, both in PsO and PsA patients (61.2% vs 16.8%, p < 0.0001 and 60.1% vs 22%, p < 0.0001, respectively). Among patients with PsO, 20% (95% CI: 7-41%) and 14% (95% CI: 4-32%) of those with and without clinical nail involvement showed enthesopathy on US examination, respectively (p = 0.54). Among PsA patients, the prevalence of enthesopathy was 30% (95% CI: 15-49%) for patients with clinical nail involvement and 35% (95% CI: 17-56%) for those without nail involvement (p = 0.71).
Nail disease was associated with DIP US enthesopathy. There was a significant increased prevalence of extensor tendon enthesopathy in fingers with involved nails both in PsO and PsA, although no association was found between nail involvement and extensor tendon enthesopathy at patients' level. These features might support the nail-entheseal pathogenesis theory at DIP level.
已有研究表明，银屑病患者的指甲受累与系统性附着病有关。我们的目的是评估银屑病（PsO）和银屑病关节炎（PsA）患者指甲受累与远侧指间关节（DIP）水平附着病的关系。
本横断面研究纳入了在门诊就诊的连续患者（54 例 PsO 和 56 例 PsA）。所有患者在同一天接受临床和超声（US）评估。
US 显示，在 9 例 PsO 患者（17%，95%CI：8-29%）和 18 例 PsA 患者（32%，95%CI：20-46%）中至少有 1 个 DIP 关节存在附着病。与无临床指甲受累的手指相比，在 PsO 和 PsA 患者中，手指的伸肌腱附着病在临床指甲受累的手指中更为常见（61.2%对 16.8%，p < 0.0001 和 60.1%对 22%，p < 0.0001）。在 PsO 患者中，有临床指甲受累的患者中有 20%（95%CI：7-41%）和无临床指甲受累的患者中有 14%（95%CI：4-32%）在 US 检查中出现附着病（p = 0.54）。在 PsA 患者中，有临床指甲受累的患者附着病的患病率为 30%（95%CI：15-49%），无指甲受累的患者为 35%（95%CI：17-56%）（p = 0.71）。
指甲疾病与 DIP US 附着病有关。在 PsO 和 PsA 中，受累指甲的手指伸肌腱附着病的患病率显著增加，尽管在患者水平未发现指甲受累与伸肌腱附着病之间存在关联。这些特征可能支持 DIP 水平的指甲-附着点发病机制理论。
