Esposito Maria, Magnanimi Lina Maria, Antonetti Paolo, De Berardinis Andrea, Pellegrini Cristina, Vagnozzi Emanuele, Bruni Manfredo, Gianneramo Camilla, Cipriani Paola, Fargnoli Maria Concetta, Barile Antonio, Ruscitti Piero
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Dermatol Pract Concept. 2025 Jul 31;15(3):5318. doi: 10.5826/dpc.1503a5318.
In patients with plaque type psoriasis (PsO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PsO patients, with a wide spectrum of clinical features, and is a significant predictor of enthesitis, often associated with early PsA stages.
This study aimed to clinically and ultrasonographically evaluate nail units in PsO patients, focusing on differences between those with/without PsA and those with/without onychopathy.
Sixty patients were enrolled (23/60 PsO and 37/60 PsO and PsA). PsO and PsA patients were evaluated and compared, as were patients with/without diagnosis of nail psoriasis in this cross-sectional single-center study. Nail abnormalities were evaluated by high frequency ultrasound (HFUS) using high frequency probes (27 MHz). After a descriptive assessment, the Nail Psoriasis Severity Index (NAPSI) and the Brown University Nail Enthesis Scale (BUNES) were used to clinically and ultrasonographically assess nails.
HFUS evaluation identified a spectrum of nail and blood flow alterations. Nail disease was characterized by median NAPSI 16 (range 28), median BUNES morphometry 1.5 (range 0.9), and median BUNES power doppler (PD) 2.2 (range 4.03). Among the studied sample, 43/60 (71.7%) presented nail psoriasis, with 69.7% presenting coexisting PsA as compared to PsO patients (30.3%) (P=0.04).
Our findings highlight the importance of close collaboration between dermatologists and rheumatologists in the evaluation of PsO patients, taking advantage of both clinical and ultrasonographic assessment of nail damage.
在斑块型银屑病（PsO）患者中，进展为银屑病关节炎（PsA）会加剧疾病的影响并增加残疾风险。甲银屑病（NP）影响高达90%的PsO患者，具有广泛的临床特征，并且是附着点炎的重要预测指标，常与PsA早期阶段相关。
本研究旨在对PsO患者的甲单位进行临床和超声评估，重点关注有无PsA以及有无甲病变患者之间的差异。
纳入60例患者（23例为单纯PsO，37例为PsO合并PsA）。在这项横断面单中心研究中，对PsO和PsA患者进行了评估和比较，同时也对有无甲银屑病诊断的患者进行了比较。使用高频探头（27MHz）通过高频超声（HFUS）评估甲异常情况。在进行描述性评估后，使用甲银屑病严重程度指数（NAPSI）和布朗大学甲附着点量表（BUNES）对甲进行临床和超声评估。
HFUS评估发现了一系列甲和血流改变。甲病的特征为NAPSI中位数为16（范围为28），BUNES形态学中位数为1.5（范围为0.9），BUNES功率多普勒（PD）中位数为2.2（范围为4.03）。在研究样本中，43/60（71.7%）存在甲银屑病，与单纯PsO患者（30.3%）相比，69.7%的患者同时存在PsA（P=0.04）。
我们的研究结果强调了皮肤科医生和风湿病学家在评估PsO患者时密切合作的重要性，同时利用临床和超声对甲损伤进行评估。
