Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Nail Disease in Psoriasis Is Associated with Sonographically Determined Systemic Subclinical Enthesopathy.
Ash1, Zoe R., Tinazzi2, Ilaria, Castillo-Gallego3, Concepcion, Kwok4, Chung, Wilson5, Caroline, Goodfield5, Mark, Gisondi6, Paolo
University of Leeds, Leeds, United Kingdom
University of Leeds and Leeds Teaching Hospitals, Leeds, United Kingdom
University of Verona, Verona, Italy
Hospital Universitario La Paz, Madrid, Spain
Leeds Teaching Hospitals, Leeds, United Kingdom
Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
University of Veronia, Verona, Italy
Leeds Institute of Molecular Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, Leeds, United Kingdom
Leeds Institute of Molecular Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK, Leeds, United Kingdom
Goztepe Training and Research Hospital, Istanbul, Turkey
Psoriasis is associated with subclinical enthesopathy and psoriatic nail disease predicts psoriatic arthritis development. Based on previous observations that the nail is directly anchored in the entheses around the distal interphalangeal joint, this study tested the hypothesis that nail disease in psoriasis was more strongly associated with systemic subclinical enthesopathy than psoriasis without nail disease.
Forty six patients with psoriasis (without arthritis) were evaluated for the presence of nail disease. Thirty-one of the forty-six psoriasis cases had clinical nail disease. Twenty-one sex and age matched healthy controls (HC) were also recruited. A total of 804 entheses were scanned including the upper and lower limbs entheses by an ultrasonographer blinded to clinical details.
Patients with psoriasis had higher enthesitis scores than HC [med (range): 21 (065) vs. 11 (339), p=0.005]. The enthesitis scores of psoriasis patients with nail disease [23 (065)] were higher than both patients without nail disease [15 (526), p=0.02] and HC [11 (339), p=0.003]. Sonographically determined inflammation scores of the entheses in patients with nail disease [13 (034)] were higher than in patients without nail disease [8 (215), p=0.02] and HC [5 (019), p<0.001]. Modified NAPSI (nail psoriasis severity index) scores on all nails were correlated to both inflammation (r2=0.45, p=0.005) and chronicity entheseal US scores (r2=0.35, p=0.04). The duration of psoriasis also tended to correlate with entheseal inflammation (r2=0.29; p=0.05) whereas no link between PASI and US scores was evident.
These findings confirm that systemic subclinical enthesopathy is common in psoriasis and shows a specific link with contemporaneous nail disease thus offering a novel microanatomical basis for the predictive value of nail psoriasis for PsA evolution.
To cite this abstract, please use the following information:
Ash, Zoe R., Tinazzi, Ilaria, Castillo-Gallego, Concepcion, Kwok, Chung, Wilson, Caroline, Goodfield, Mark, et al; Nail Disease in Psoriasis Is Associated with Sonographically Determined Systemic Subclinical Enthesopathy. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2486F