Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
Clin Rheumatol. 2022 Jul;41(7):2065-2069. doi: 10.1007/s10067-022-06107-0. Epub 2022 Feb 19.
Nail disease in psoriasis has been found to be associated with psoriatic arthritis (PsA); however, which subtype of nail disease holds greater relevance to PsA remains unclear. This study was performed to explore the associations between three subtypes of fingernail disease (pitting, onycholysis, and hyperkeratosis) and PsA among patients with psoriasis. Patients with psoriasis attending five dermatology clinics in Shanghai between January 2020 and May 2021 were examined for skin, joint, and fingernail changes. Multivariate logistic regression analyses were utilized to test the strength of associations between subtypes of fingernail disease and PsA. The receiver operator characteristic (ROC) curve with area under curve (AUC) was used to evaluate their accuracies in diagnosing PsA. Sensitivity and specificity were also calculated. Of 1985 patients with psoriasis included, 228 (11.5%) patients were diagnosed with PsA, and the remaining patients were cutaneous-only psoriasis (PsC). One-hundred and fifty-seven (68.9%) patients with PsA and 748 (42.6%) patients with PsC had fingernail disease. Adjusted models showed that onycholysis and hyperkeratosis were the only type of fingernail disease independently associated with PsA. This association was further confirmed by the forward conditional stepwise regression model (OR, 95% CI for onycholysis: 2.34, 1.79 to 4.27, p < 0.01; for hyperkeratosis: 1.62, 1.12 to 2.66, p = 0.037). ROC analysis showed that, compared to pitting and hyperkeratosis, onycholysis had higher AUC (0.630) and sensitivity (52.6%). The psoriatic fingernail onycholysis and hyperkeratosis hold greater relevance to PsA than pitting. Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis. Key Points • Psoriatic fingernail onycholysis and hyperkeratosis, rather than pitting, are significantly associated with PsA • Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis.
银屑病相关的甲病与银屑病关节炎（PsA）有关；然而，哪种甲病亚型与 PsA 的相关性更大尚不清楚。本研究旨在探讨三种甲病亚型（凹点、甲分离和角化过度）与上海五家皮肤科诊所 2020 年 1 月至 2021 年 5 月间就诊的银屑病患者中 PsA 的相关性。对患有银屑病的患者进行皮肤、关节和甲变化的检查。采用多变量逻辑回归分析检验甲病亚型与 PsA 之间的关联强度。采用受试者工作特征（ROC）曲线及其曲线下面积（AUC）评估其诊断 PsA 的准确性。同时计算了灵敏度和特异性。在纳入的 1985 例银屑病患者中，228 例（11.5%）患者被诊断为 PsA，其余患者为单纯皮肤银屑病（PsC）。157 例（68.9%）PsA 患者和 748 例（42.6%）PsC 患者患有甲病。调整后的模型显示，甲分离和角化过度是唯一与 PsA 独立相关的甲病类型。这一关联在向前条件逐步回归模型中得到了进一步证实（甲分离的 OR 为 95%CI：2.34，1.79 至 4.27，p < 0.01；角化过度的 OR 为 1.62，1.12 至 2.66，p = 0.037）。ROC 分析显示，与凹点和角化过度相比，甲分离的 AUC（0.630）和灵敏度（52.6%）更高。银屑病指甲的甲分离和角化过度与 PsA 的相关性强于凹点。临床上，指甲有甲分离和角化过度的银屑病患者应评估关节炎。关键点：
与 PsA 显著相关的银屑病甲病为甲分离和角化过度，而非凹点；
临床上，指甲有甲分离和角化过度的银屑病患者应评估关节炎。
