Agache Mihaela, Popescu Claudiu C, Enache Luminița, Dumitrescu Bianca M, Codreanu Cătălin
Department of Internal Medicine and Rheumatology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania.
Diagnostics (Basel). 2023 Jun 30;13(13):2236. doi: 10.3390/diagnostics13132236.
Ultrasonography has advantages for assessing psoriatic arthritis (PsA) due to its ability to evaluate several targets, including joints, entheses, and tendons, but also skin and nails. Although ultrasound is widely used in PsA, nail ultrasound, despite its potential as a non-invasive method for the early detection of inflammation in the nail apparatus, has low applicability in medical practice, as probes with a higher frequency are needed compared with the frequency of probes usually used. In the present article, we have narratively evaluated the studies published in the last 5 years (19 February 2018-18 February 2023) on nail ultrasound value in the diagnosis and monitoring of PsA. The studies published during this period share common measurement parameters, such as the OMERACT definition of enthesis published in 2018. We included original articles published in PubMed and Web of Science using the following search terms in all possible combinations: psoriatic arthritis, psoriasis, ultrasound, and nail. Articles were declared relevant if they presented data on nail morphology, power Doppler evaluation and nearby structure evaluation, while focusing on digitorum extensor enthesitis. In most of the studies, common morphological parameters were generally increased in patients with psoriasis or PsA and were demonstrated to change with medication. The thickness of the extensor tendon was greater in patients with PsA and psoriasis versus controls and it was correlated with nail clinical changes, especially the presence of onycholysis. The presence of PD showed large variability in healthy individuals. The link between enthesitis and nail involvement is still a subject of controversy, taking into account the latest histological findings. The use of ultrasound in the evaluation of nail and DIP enthesitis remains a challenge and an area of research in the coming years.
超声检查在评估银屑病关节炎（PsA）方面具有优势，因为它能够评估多个目标，包括关节、附着点和肌腱，还能评估皮肤和指甲。尽管超声在PsA中被广泛应用，但指甲超声检查，尽管其作为一种非侵入性方法在早期检测甲床炎症方面具有潜力，但在医学实践中的适用性较低，因为与通常使用的探头频率相比，需要更高频率的探头。在本文中，我们对过去5年（2018年2月19日至2023年2月18日）发表的关于指甲超声在PsA诊断和监测中的价值的研究进行了叙述性评估。在此期间发表的研究共享了常见的测量参数，如2018年发表的附着点的OMERACT定义。我们纳入了在PubMed和Web of Science上发表的原始文章，使用以下搜索词的所有可能组合：银屑病关节炎、银屑病、超声和指甲。如果文章呈现了关于指甲形态、能量多普勒评估和附近结构评估的数据，同时关注指伸肌腱附着点炎，则被判定为相关。在大多数研究中，银屑病或PsA患者的常见形态学参数普遍增加，并被证明会随药物治疗而改变。与对照组相比，PsA和银屑病患者的伸肌腱厚度更大，并且与指甲临床变化相关，尤其是甲分离的存在。健康个体中能量多普勒的存在显示出很大的变异性。考虑到最新的组织学发现，附着点炎与指甲受累之间的联系仍然是一个有争议的话题。在未来几年，超声在评估指甲和远端指间关节附着点炎方面的应用仍然是一个挑战和研究领域。
