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Mehl AC, Schmidt LM, Azevedo VF. Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores? Adv Rheumatol 2024; 64:75. [PMID: 39334491 DOI: 10.1186/s42358-024-00398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 07/30/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Psoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings. OBJECTIVES To describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)). METHODS This was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student's t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher's exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification. RESULTS The Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some correlations between US findings and clinical scores: ultrasound nail involvement and the NAPSI score (p = 0.034), the number of fingers and mean change in the nail plate and the ASDAS-CRP (p = 0.030). DAPSA (remission/low activity versus moderate/high activity) was associated to the mean change in the nail plate (p < 0.013). CONCLUSIONS Nail ultrasound has the potential to assist in the capturing of the actual disease activity status in patients with psoriatic arthritis.
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Affiliation(s)
| | | | - Valderílio Feijó Azevedo
- Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Parana, Brazil
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Mahmoud I, Rouached L, Rahmouni S, Ben Dhia S, Ben Tekaya A, Bouden S, Tekaya R, Hamdi W, Saidane O, Abdelmoula L. Ultrasound Assessment of Psoriatic Arthritis Patients With Clinically Normal Nails and Evaluation of its Correlation With the Disease Activity: A Case-Control Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1413-1420. [PMID: 38634658 DOI: 10.1002/jum.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Nail unit is one of the targets of ultrasound (US) assessment. We aimed to compare ultrasound parameters of clinically normal nail unit in psoriatic arthritis (PsA) patients with healthy controls (HC) and evaluate their correlations with disease activity. METHODS This was a cross-sectional study including patients with PsA and matched HC. Tender (TJC) and swollen joint count (SJC), Psoriasis Area and Severity Index (PASI), and Disease Activity in Psoriatic Arthritis (DAPSA) were collected in PsA patients. Patients underwent US assessment of fingernails with a study of morphological changes and measurement of the thickness of nail bed (NBT), nail plate (NPT), and adjacent skin (ST). Correlation between nail unit parameters and disease activity was studied. RESULTS We evaluated 22 PsA patients (219 nails) and 21 HC (210 nails). Mean DAPSA was 21.56 ± 14.36 and mean PASI was 2.19 ± 3.8. PsA patients had more US morphological changes than HC (16.89 vs 3.33%, P = .03). NPT comparison between identical fingernails of PsA and HC did not reveal significant difference. However, NBT was significantly higher in HC (1.77 vs 2.07 mm, P = .027) as well as ST (2.26 vs 2.59 mm, P = .003). TJC and ST were positively correlated (r = .46, P = .03). No correlation was noted between disease activity scores and NPT, NBT, or ST in PsA patients. In biologic parameters, ESR was negatively correlated with ST (r = -.41, P = .05). CONCLUSIONS Nail bed and adjacent skin US morphological changes were contributive to distinguish psoriatic from healthy nails. Adjacent skin thickness measurement was positively correlated with TJC and ESR, suggesting that it could be used as an indicator of disease activity in PsA.
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Affiliation(s)
- Ines Mahmoud
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Safa Rahmouni
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Rheumatology Department, La Rabta Hospital, Tunis, Tunisia
| | - Siwar Ben Dhia
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Aicha Ben Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Wafa Hamdi
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Rheumatology Department, Kassab Institute, Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
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Vargas EAT, Finato VML, Azulay-Abulafia L, Leverone A, Nakamura R, Wortsman X. Ultrasound of Nails: Why, How, When. Semin Ultrasound CT MR 2024; 45:233-250. [PMID: 38056789 DOI: 10.1053/j.sult.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Nail disorders are frequently a challenge to diagnose correctly only based on clinical findings. Moreover, biopsies may leave scars due to damage to the nail matrix. Currently, high-frequency ultrasound (HFUS) with probes >15 MHz is the first-choice imaging technique to study the nail. Compared with other imaging tests such as computed tomography and magnetic resonance imaging, HFUS has the advantage of high-resolution imaging of the nail apparatus without exposure to radiation, contrast media, and the risk of claustrophobia of these other expensive imaging methods. Notably, the axial spatial resolution of HFUS is higher than computed tomography and magnetic resonance imaging; therefore, it can better discriminate the anatomical alterations. Our objective is to review the main applications of HFUS of the nail through literature analysis and illustration of cases of the most frequent pathologies found in our experience, exemplifying why, how, and when HFUS could help diagnose nail diseases.
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Affiliation(s)
- Estêvão A T Vargas
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Luna Azulay-Abulafia
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues (IDIEP), Santiago, Chile; Department of Dermatology, Universidad de Chile, Santiago, Chile; Department of Dermatology, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Wortsman X. Role of Color Doppler Ultrasound in Cutaneous Inflammatory Conditions. Semin Ultrasound CT MR 2024; 45:264-286. [PMID: 38056784 DOI: 10.1053/j.sult.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Inflammatory cutaneous diseases can be challenging to diagnose and manage. Nowadays, the anatomical information provided by ultrasound is critical for detecting subclinical alterations and assessing the severity and activity of these conditions. Many of these entities can be clinically observed in dermatology and other specialties, such as rheumatology, plastic surgery, ophthalmology, and otolaryngology, among others. We review the ultrasonographic patterns of the most common inflammatory cutaneous conditions. In several cases, such as hidradenitis suppurativa, acne, and morphea, there are ultrasonographic staging systems of severity or activity that are pivotal in the management of these diseases. The early ultrasonographic diagnosis of these entities implies a proper management of the patients and, therefore, improve their quality of life. Thus, knowledge of the current use of ultrasound in this field seems essential.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Kulaksız B, Palamar D, Misirlioglu TO, Akgun K, Terlemez R. Ultrasonographic Evaluation of Nail Involvement in Patients With Axial Spondyloarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:967-978. [PMID: 38323351 DOI: 10.1002/jum.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES This study aimed to evaluate the nail units of patients with axial spondyloarthritis (ax-SpA) using ultrasound and to identify any subclinical changes. We also aimed to examine the relationship between clinical enthesitis scores and nail involvement in patients with ax-SpA. METHODS The study included 40 patients with ax-Spa, 40 patients with psoriatic arthritis (PsA), and 40 healthy controls. The thickness of the nail plates, morphological changes, the thickness of the proximal nail units, the thickness of the nail beds, and power Doppler signal intensities were evaluated and compared. Maastricht Ankylosing Spondylitis Enthesitis Score and Spondyloarthritis Research Consortium of Canada Enthesitis Index were also evaluated in patients with ax-SpA. RESULTS There was no significant difference between the thickness of the nail plates of the three groups (P > .05). The first nail bed thickness of ax-SpA cases was significantly higher than the control group (P = .046), and the fourth and fifth nail proximal unit thicknesses of the control group were significantly lower than the ax-SpA and PsA groups (P = .023, P = .017). We also found that the Wortsman scores of the cases with PsA were significantly higher than the ax-SpA and control groups (P = .0001). CONCLUSION The thickness of the proximal nail unit adjacent to the insertion of the digital extensor tendon, which is considered as the enthesis area, is similar to the patients with PsA in patients with ax-SpA, especially in the fourth and fifth fingers compared to the control group. On the other hand, almost no structural changes in nail plates were observed in patients with ax-SpA group.
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Affiliation(s)
- Bilal Kulaksız
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Saleah SA, Kim S, Luna JA, Wijesinghe RE, Seong D, Han S, Kim J, Jeon M. Optical Coherence Tomography as a Non-Invasive Tool for Plant Material Characterization in Agriculture: A Review. SENSORS (BASEL, SWITZERLAND) 2023; 24:219. [PMID: 38203080 PMCID: PMC10781338 DOI: 10.3390/s24010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
Characterizing plant material is crucial in terms of early disease detection, pest control, physiological assessments, and growth monitoring, which are essential parameters to increase production in agriculture and prevent unnecessary economic losses. The conventional methods employed to assess the aforementioned parameters have several limitations, such as invasive inspection, complexity, high time consumption, and costly features. In recent years, optical coherence tomography (OCT), which is an ultra-high resolution, non-invasive, and real-time unique image-based approach has been widely utilized as a significant and potential tool for assessing plant materials in numerous aspects. The obtained OCT cross-sections and volumetrics, as well as the amplitude signals of plant materials, have the capability to reveal vital information in both axial and lateral directions owing to the high resolution of the imaging system. This review discusses recent technological trends and advanced applications of OCT, which have been potentially adapted for numerous agricultural applications, such as non-invasive disease screening, optical signals-based growth speed detection, the structural analysis of plant materials, and microbiological discoveries. Therefore, this review offers a comprehensive exploration of recent advanced OCT technological approaches for agricultural applications, which provides insights into their potential to incorporate OCT technology into numerous industries.
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Affiliation(s)
- Sm Abu Saleah
- ICT Convergence Research Center, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Shinheon Kim
- Institute of Biomedical Engineering, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Jannat Amrin Luna
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; (J.A.L.)
| | - Ruchire Eranga Wijesinghe
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Sri Lanka Institute of Information Technology, Malabe 10115, Sri Lanka
| | - Daewoon Seong
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; (J.A.L.)
| | - Sangyeob Han
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; (J.A.L.)
| | - Jeehyun Kim
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; (J.A.L.)
| | - Mansik Jeon
- School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; (J.A.L.)
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Michelucci A, Dini V, Salvia G, Granieri G, Manzo Margiotta F, Panduri S, Morganti R, Romanelli M. Assessment and Monitoring of Nail Psoriasis with Ultra-High Frequency Ultrasound: Preliminary Results. Diagnostics (Basel) 2023; 13:2716. [PMID: 37627974 PMCID: PMC10453049 DOI: 10.3390/diagnostics13162716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Psoriatic onychopathy is one of the clinical presentations of psoriasis and a well-known risk factor for the development of psoriatic arthritis. High-frequency ultrasounds (HFUS > 20 MHz) have recently been used to evaluate the nail apparatus of healthy and psoriatic subjects. The aim of our study was to detect by means of ultra-high-frequency ultrasound (UHFUS 70-100 MHz) alterations of the nail bed and matrix in patients with psoriatic onychopathy and to monitor these parameters during the treatment with monoclonal antibody (mAb). We enrolled 10 patients with psoriatic onychopathy and naive to previous biologic therapies. Patients were evaluated at baseline, after 1 month and after 3 months from the beginning of mAb therapy by a complete clinical assessment and US evaluation. A UHFUS examination with a 70 MHz probe was performed on the thumbnail (I), the index fingernail (II) and the nail with greater clinical impairment (W). The following measurements were analyzed: nail plate thickness (A), nail bed thickness (B), nail insertion length (C), nail matrix length (D) and nail matrix thickness (E). Among the various parameters analyzed, some measures showed a statistically significant decrease with p-value < 0.05 (t0 WA = 0.52 mm vs. t2 WA = 0.42 mm; t0 WB = 2.8 mm vs. t2 WB = 2.4 mm; t0 WE = 0.76 mm vs. t2 WE = 0.64 mm; t0 IIA = 0.49 mm vs. t2 IIA = 0.39 mm). In conclusion, UHFUS could represent a viable imaging technique for the real-time evaluation and monitoring of psoriatic onychopathy, thus supporting the clinical parameters and revealing any subclinical signs of early drug response.
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Affiliation(s)
- Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Giorgia Salvia
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Giammarco Granieri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Salvatore Panduri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, 56126 Pisa, Italy;
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (A.M.); (G.S.); (G.G.); (F.M.M.); (S.P.); (M.R.)
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Subhas N, Wu F, Fox MG, Nacey N, Aslam F, Blankenbaker DG, Caracciolo JT, DeJoseph DA, Frick MA, Jawetz ST, Said N, Sandstrom CK, Sharma A, Stensby JD, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023; 20:S20-S32. [PMID: 37236743 DOI: 10.1016/j.jacr.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Fangbai Wu
- Research Author, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael G Fox
- Program Director and Panel Chair, Mayo Clinic Arizona, Phoenix, Arizona
| | - Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia
| | - Fawad Aslam
- Mayo Clinic, Scottsdale, Arizona, Rheumatologist
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Section Head, Musculoskeletal Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; and Chair, MSK-RADS (Bone) Committee
| | | | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Claire K Sandstrom
- University of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Chai K, Zhu R, Luo F, Shi Y, Liu M, Xiao Y, Xiao R. Updated Role of High-frequency Ultrasound in Assessing Dermatological Manifestations in Autoimmune Skin Diseases. Acta Derm Venereol 2022; 102:adv00765. [PMID: 36000997 PMCID: PMC9558316 DOI: 10.2340/actadv.v102.1969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Autoimmune skin diseases are a group of disorders that arise due to the dysregulated immune system attacking self-antigens, causing multiple tissue and organ lesions. With disease progression, the physical and psychological health of patients may be seriously damaged. High-frequency ultrasound is non-invasive, reproducible, and suitable for visualizing the fine structure of external organs. The usage of high-frequency ultrasound has increased in recent years in the auxiliary diagnosis and monitoring of various skin diseases; it serves as a promising tool for dermatological disease assessment. This review summarizes the characteristics of high-frequency ultrasound imaging in common autoimmune skin diseases, including systemic lupus erythematosus, scleroderma, psoriasis, dermatomyositis, and pemphigus/pemphigoid. The objective of this review is to provide new ideas and strategies for dermatologists to diagnose and track the prognosis of autoimmune skin diseases.
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Affiliation(s)
| | | | | | | | | | - Yangfan Xiao
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Rong Xiao
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China.
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Usefulness of Ultrasound Examination in the Assessment of the Nail Apparatus in Psoriasis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095611. [PMID: 35565018 PMCID: PMC9105627 DOI: 10.3390/ijerph19095611] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
The assessment of psoriatic nail changes in everyday practice is based exclusively on clinical symptoms that do not reflect the entire disease process in the nail apparatus. The use of imaging methods, especially widely available and inexpensive ultrasonography, creates the possibility of additional revealing and assessing grayscale of morphological changes of the ventral nail plate, nail bed, and matrix, as well as the attachment of the finger extensor tendon to the distal phalanx. What is more, it enables the assessment of inflammation severity in the power Doppler technique. A qualitative classification of nail plate morphological changes corresponding to the severity of psoriatic nail changes has been developed so far and attempts are being made to develop a quantitative method to assess not only the presence of changes but also the severity of inflammation. Nail ultrasonography is not commonly performed, although published studies indicate the possible use of this technique in the assessment of psoriatic changes in nail structures. It can be particularly useful in subclinical changes imaging, preceding clinical manifestation of psoriatic nail changes, enthesopathy: subclinical and in the course of psoriatic arthritis, as well as in the assessment of treatment efficacy. This review article aims to summaries the research on ultrasonography of the nail apparatus which has been carried out so far, taking into account its applicability in clinical practice.
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Canal-García E, Bosch-Amate X, Belinchón I, Puig L. Psoriasis ungueal. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:481-490. [DOI: 10.1016/j.ad.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022] Open
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Canal-García E, Bosch-Amate X, Belinchón I, Puig L. [Translated article] Nail Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mease PJ, Bhutani MK, Hass S, Yi E, Hur P, Kim N. Comparison of Clinical Manifestations in Rheumatoid Arthritis vs. Spondyloarthritis: A Systematic Literature Review. Rheumatol Ther 2022; 9:331-378. [PMID: 34962619 PMCID: PMC8964901 DOI: 10.1007/s40744-021-00407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Misclassification of spondyloarthritis (SpA) as rheumatoid arthritis (RA) may lead to delayed SpA diagnosis and suboptimal therapeutic outcomes. Here, we evaluate the literature on clinical manifestations in patients with SpA and RA, particularly seronegative RA, to understand the potential overlap, distinctions, and most reliable approaches to accurate diagnosis. METHODS In this systematic literature review, conducted according to PRISMA guidelines, we searched key biomedical databases for English-language publications of original research articles (up to July 23, 2020) and rheumatology conference abstracts (January 1, 2018-July 31, 2020) reporting key SpA clinical presentations in patients with SpA or RA. Publications were assessed for eligibility by two independent reviewers; discrepancies were resolved by a third. Studies were evaluated for publication quality using the Downs and Black checklist. RESULTS Of 4712 records retrieved, 79 met the inclusion criteria and were included in the analysis. Of these, 54 included study populations with SpA and RA, and 25 with seropositive and/or seronegative RA. Entheseal abnormalities were more frequently reported among patients with SpA than RA and with seronegative vs. seropositive RA. Psoriasis, nail psoriasis, and dactylitis were exclusively seen in SpA vs. RA. In most publications (70 of 79), advanced imaging techniques allowed for more accurate distinction between SpA and RA. Overlapping clinical characteristics occur in SpA and RA, including inflammation and destruction of joints, pain, diminished functional ability, and increased risk for comorbidities. However, of 54 studies comparing SpA and RA populations, only seven concluded that no distinction can be made based on the SpA manifestations and outcomes examined. CONCLUSIONS Typical SpA-related clinical symptoms and signs were observed in patients with RA, suggesting that misclassification could occur. Availability of advanced imaging modalities may allow for more prompt and comprehensive evaluation of peripheral manifestations in SpA and RA, reducing misclassification and delayed diagnosis.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA.
- Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA, 98122, USA.
| | | | | | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Nina Kim
- Baylor Scott & White Health, Temple, TX, USA
- University of Texas at Austin, Austin, TX, USA
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Ortner VK, Mandel VD, Bertugno S, Philipsen PA, Haedersdal M. Imaging of the Nail Unit in Psoriatic Patients - a Systematic Scoping Review of Techniques and Terminology. Exp Dermatol 2022; 31:828-840. [PMID: 35353919 PMCID: PMC9323418 DOI: 10.1111/exd.14572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Background The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities. Objective To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology. Methods For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique. Results After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales. Conclusions This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.
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Affiliation(s)
- V K Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - V D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - S Bertugno
- Radiology Unit, Bernardino Ramazzini Hospital, Carpi, Italy
| | - P A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
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Ruscitti P, Esposito M, Gianneramo C, Di Cola I, De Berardinis A, Martinese A, Nkamtse Tochap G, Conforti A, Masciocchi C, Cipriani P, Barile A, Fargnoli MC. Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study. LA RADIOLOGIA MEDICA 2022; 127:1400-1406. [PMID: 36260243 PMCID: PMC9747848 DOI: 10.1007/s11547-022-01568-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To characterize nail and enthesis abnormalities using high frequency ultrasound (HFUS) in patients with psoriasis (PSO), psoriatic arthritis (PSA) with PSO, and PSA sine PSO. MATERIAL AND METHODS Patients with PSO, PSA with PSO, and PSA sine PSO were evaluated and compared in a cross-sectional single centre study. Nail and enthesis abnormalities were evaluated by HFUS using high frequency probes (27 MHz). After a descriptive assessment, Brown University Nail Enthesis Scale (BUNES) and Madrid Sonography Enthesitis Index (MASEI) were used to assess nail and enthesis, respectively. RESULTS Fifty-nine patients were enrolled (19 PSO, 22 PSA with PSO, 18 PSA sine PSO). In patients with PSO and in those with PSA and PSO, HFUS evaluation identified the following nail alterations characterised by thickened matrix, inhomogeneous echogenicity of the nail bed, and increased blood flow by power Doppler. In 38.9% patients with PSA sine PSO, a subclinical nail involvement was described. No difference was observed comparing BUNES values in three groups. In PSA patients with PSO and in those with PSA sine PSO, HFUS assessment of entheses mainly showed a hypoechoic aspect and thickness of the tendon, focal cortical erosion, and ossification. A subclinical enthesis involvement in 47.4% patients with PSO was observed. No difference was reported comparing MASEI values in three groups. CONCLUSION Qualitative and quantitative abnormalities of nail and enthesis were demonstrated by HFUS in patients with PSO, PSA with PSO, and PSA sine PSO, suggesting a practical additional tool to be used in clinical settings. Furthermore, HFUS highlighted a subclinical nail involvement in patients with PSA sine PSO and enthesis subclinical alterations in patients with PSO.
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Affiliation(s)
- Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy.
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Camilla Gianneramo
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, L'Aquila, Italy
| | - Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Andrea De Berardinis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Andrea Martinese
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Gerard Nkamtse Tochap
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Alessandro Conforti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, PO box 67100, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, L'Aquila, Italy
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Wang Z, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial. Ann Rheum Dis 2021; 81:225-231. [PMID: 34911706 PMCID: PMC8762015 DOI: 10.1136/annrheumdis-2021-221019] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/11/2021] [Indexed: 01/20/2023]
Abstract
Objective To evaluate risankizumab, a biological therapy that inhibits interleukin 23, in patients with active psoriatic arthritis (PsA) who have responded inadequately or are intolerant to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD). Methods In the randomised, placebo-controlled, double-blind KEEPsAKE 1 trial, 964 patients with active PsA were randomised (1:1) to receive risankizumab 150 mg or placebo at weeks 0, 4 and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology criteria (ACR20) at week 24. Here, we report the results from the 24-week double-blind period; the open-label period with all patients receiving risankizumab is ongoing. Results At week 24, a significantly greater proportion of patients receiving risankizumab achieved the primary endpoint of ACR20 (57.3% vs placebo, 33.5%; p<0.001). Significant differences were also observed for risankizumab versus placebo for the first eight ranked secondary endpoints, including skin and nail psoriasis endpoints, minimal disease activity and resolution of enthesitis and dactylitis (p<0.001). Adverse events and serious adverse events were reported at similar rates in the risankizumab and placebo groups. Serious infections were reported for 1.0% and 1.2% of patients receiving risankizumab and placebo, respectively. There was one death in the risankizumab group (urosepsis deemed unrelated to the study drug). Conclusions Risankizumab treatment results in significantly greater improvement of signs and symptoms of PsA compared with placebo and is well tolerated in patients with active PsA who have responded inadequately or are intolerant to ≥1 csDMARD. Trial registration number NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research-K Papp Clinical Research, Waterloo, Ontario, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA, and Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand, and Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Wenjing Lu
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - Ann Eldred
- AbbVie Inc, North Chicago, Illinois, USA
| | | | - Frank Behrens
- CIRI/Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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Abstract
Ultrasound has evolved in dermatology from an experimental phase to a daily practice imaging technique. Its several advantages include its safety, good balance between penetration and resolution, high definition, and the detection of blood flow in real time. Its applications are growing and include the support of the diagnosis and extent in all axes, including depth, vascularity patterns, staging, and follow up of multiple cutaneous diseases-benign cutaneous tumors, vascular anomalies, nail lesions, skin cancer, inflammatory cutaneous diseases, and aesthetics complications.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Departments of Dermatology, Universidad de Chile and Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Ji C, Wang H, Bao C, Zhang L, Ruan S, Zhang J, Gong T, Cheng B. Challenge of Nail Psoriasis: An Update Review. Clin Rev Allergy Immunol 2021; 61:377-402. [PMID: 34478047 DOI: 10.1007/s12016-021-08896-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Psoriatic nail involving matrix can cause pitting, leukonychia, red spots in lunula, and nail plate crumbling, while nail bed involvement can result in onycholysis, oil-drop discoloration, nail bed hyperkeratosis, and splinter hemorrhages. The common assessment methods of evaluating nail psoriasis includes Nail Psoriasis Severity Index (NAPSI), Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Nail Psoriasis Quality of life 10 (NPQ10), and so on. Treatment of nail psoriasis should be individualized according to the number of involving nail, the affected site of nail and presence of skin and/or joint involvement. Generally, topical therapies are used for mild nail psoriasis, while biologic agents such as etanercept are considered for severe nail disease and refractory nail psoriasis. Even though the current literature has shown some support for the pathogenesis, clinical presentation, or therapies of nail psoriasis, systemic review of this multifaceted disease is still rare to date. We elaborate recent developments in nail psoriasis epidemiology, pathogenesis, anatomy, clinical manifestation, diagnosis, differential diagnosis, and therapies to raise better awareness of the complexity of nail psoriasis and the need for early diagnosis or intervention.
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Affiliation(s)
- Chao Ji
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Haiqing Wang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Chengbei Bao
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Liangliang Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Shifan Ruan
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Jing Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
| | - Bo Cheng
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
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De Rossi SD, Mendonça JA, Palominos PE, Kohem CL, Cestari TF, da Silva Chakr RM. Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study. Adv Rheumatol 2021; 61:48. [PMID: 34321109 DOI: 10.1186/s42358-021-00207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. METHODS Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. RESULTS Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). CONCLUSION Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. TRIAL REGISTRATION 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation - CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf .
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Affiliation(s)
- Samanta Daiana De Rossi
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - José Alexandre Mendonça
- Department of Rheumatology, Celso Pierro Hospital, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Penelope Ester Palominos
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles Lubianca Kohem
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tania Ferreira Cestari
- Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Mendonça da Silva Chakr
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis. J Clin Med 2021; 10:jcm10102122. [PMID: 34068890 PMCID: PMC8157176 DOI: 10.3390/jcm10102122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.
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Acer Kasman S, Gezer HH, Baklacıoğlu HŞ, Erdem Gürsoy D, Duruöz MT. A standardized sonographic analysis of nails in psoriatic arthritis and healthy controls: Feasibility, reliability, diagnostic performance, and demographic and clinical associations. Joint Bone Spine 2021; 88:105197. [PMID: 33901660 DOI: 10.1016/j.jbspin.2021.105197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Subunits of the nail can be evaluated by nail ultrasonography (NUSG). The purposes of this study are to document NUSG properties (both nail-based and participant-based evaluations) in patients with psoriatic arthritis (PsA) and healthy controls and to explore the final scorings. METHODS After the literature review and a pilot study, a consensus was reached to evaluate 12 nails and 5 parameters by NUSG: nail plate impairment (NPI), nail plate thickness (NPT), nail bed thickness (NBT), nail thickness (NT), and Doppler activity (DA); further, scorings for each parameter (NPIs, NPTs, NBTs, NTs, and DAs) were calculated. Group comparisons and diagnostic performances (with ROC curve analysis) were applied to both parameters and scorings. Final scorings to predict PsA diagnosis among the NUSG scorings were reached by regression analysis. Feasibility, reliability, and clinical associations of the scores were also performed. RESULTS Sixty-four patients with PsA and 26 controls (3240 baseline images) were assessed. The most affected nails, PsA/control comparisons, and the ROC analysis varied among the nails, within the higher values of PsA; therefore, 12 nails remained in the scorings. Participant-based scorings showed better content and diagnostic performances than the nail-based. Diagnostic performances, feasibility, reliability, and regression analysis of the scorings documented that NPIs, NTs, and DAs were the best. Some demographics, employee status, hemoglobin, and disease activity of the participants were associated with them. CONCLUSIONS The NUSG Index (NUSGI) including NPIs, NTs, and DAs is a feasible, reliable, and discriminative method to predict PsA diagnosis, with its rich content. Clinicaltrials.gov-ID: NCT04718428.
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Affiliation(s)
- Sevtap Acer Kasman
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey.
| | - Halise Hande Gezer
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey
| | - Hatice Şule Baklacıoğlu
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey; Samsun Training and Research Hospital, Rheumatology Clinic, Samsun, Turkey
| | - Didem Erdem Gürsoy
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey; Adıyaman Training and Research Hospital, Rheumatology Clinic, Adıyaman, Turkey
| | - Mehmet Tuncay Duruöz
- Marmara University School of Medicine; Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Muhsin Yazıcıoğlu Caddesi, Üst Kaynarca, Pendik, Istanbul, Turkey
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23
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Villani AP, Boutroy S, Coutisson C, Carlier MC, Barets L, Marotte H, Richert B, Chapurlat RD, Jullien D, Confavreux CB. Distal phalangeal bone erosions observed by HR-pQCT in patients with psoriatic onycholysis. Rheumatology (Oxford) 2021; 60:1176-1184. [PMID: 32885241 DOI: 10.1093/rheumatology/keaa415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES PsA prevalence among skin psoriasis is ∼30%. Nail psoriasis, especially onycholysis, is present in >70% of PsA and the risk of developing PsA is more than doubled in patients with nail involvement. We hypothesized that onycholysis may be associated with early bone erosions of the DIP joint without harbouring PsA symptoms. METHODS We compared tendon thickness, assessed by US, and bone erosions, assessed by high-resolution peripheral quantitative CT, of the DIP joint in patients with psoriatic onycholysis without PsA (ONY) with those in patients with cutaneous psoriasis only (PSO). We used patients with PsA as reference (PsA group), and healthy age-matched controls (CTRL). Differences between groups were assessed by analysis of variance tests followed by post hoc analysis using the Scheffe method. RESULTS Mean (s.e.m.) age of the 87 participants (61% males) was 45.2 (1.3) years. The mean extensor tendon thickness was significantly larger in ONY than in PSO patients. In the PsA group, 68% of patients exhibited erosions of three different shapes: V-, Omega- and U-shape. Association with erosions was greater in the ONY group than in the PSO group (frequency: 57 vs 14%; P < 0.001; mean number of erosions: 1.10 (0.35) vs 0.03 (0.03); P < 0.001). CONCLUSION Onycholysis was associated with significant enthesopathy and bone erosions in our cohort. These data support the pathogenic role of enthesopathy in PsA. Onycholysis may be considered as a surrogate marker of severity in psoriasis. TRIAL REGISTRATION ClinicalTrails.gov, https://clinicaltrials.gov, NCT02813720.
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Affiliation(s)
- Axel P Villani
- Hospices Civils de Lyon, Service de Dermatologie - Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard Lyon I, Lyon, France.,Groupe Ongle de la Société Française de Dermatologie, Paris, France
| | | | | | | | - Loïs Barets
- Hospices Civils de Lyon, Service de Rhumatologie - Hôpital Edouard Herriot, Lyon, France
| | - Hubert Marotte
- SAINBIOSE INSERM 1059, Université de Lyon, Saint Etienne, France.,Service de Rhumatologie, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Bertrand Richert
- Groupe Ongle de la Société Française de Dermatologie, Paris, France.,Département de Dermatologie - CHU Brugmann - St Pierre et Reine Fabiola, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Roland D Chapurlat
- Université Claude Bernard Lyon I, Lyon, France.,INSERM UMR 1033-LYOS, Lyon, France.,Hospices Civils de Lyon, Service de Rhumatologie - Hôpital Edouard Herriot, Lyon, France
| | - Denis Jullien
- Hospices Civils de Lyon, Service de Dermatologie - Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard Lyon I, Lyon, France
| | - Cyrille B Confavreux
- Université Claude Bernard Lyon I, Lyon, France.,INSERM UMR 1033-LYOS, Lyon, France.,Hospices Civils de Lyon, Service de Rhumatologie - Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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24
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Saleah SA, Kim P, Seong D, Wijesinghe RE, Jeon M, Kim J. A preliminary study of post-progressive nail-art effects on in vivo nail plate using optical coherence tomography-based intensity profiling assessment. Sci Rep 2021; 11:666. [PMID: 33436674 PMCID: PMC7804019 DOI: 10.1038/s41598-020-79497-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/11/2020] [Indexed: 01/29/2023] Open
Abstract
Nail beautification is a widely applied gender independent practice. Excessive nail beautifications and nail-arts have a direct impact on the nail structure and can cause nail disorders. Therefore, the assessment of post-progressive nail-art effects on the nail is essential to maintain optimal nail health and to avoid any undesirable disorders. In this study, in vivo nails were examined in control stage, with a nail-art stage, and after removing the nail-art stage using a 1310 nm spectral-domain optical coherence tomography (SD-OCT) system. The acquired cross-sectional OCT images were analyzed by a laboratory customized signal processing algorithm to obtain scattered intensity profiling assessments that could reveal the effects of nail beautification on the nail plate. The formation and progression of cracks on the nail plate surface were detected as an effect of nail beautification after 72 h of nail-art removal. Changes in backscattered light intensity and nail plate thickness of control and art-removed nails were quantitatively compared. The results revealed the potential feasibility of the developed OCT-based inspection procedure to diagnose post-progressive nail-art effects on in vivo nail plate, which can be helpful to prevent nail plate damages during art removal through real-time monitoring of the boundary between the nail plate and nail-art. Besides nail-art effects, the developed method can also be used for the investigation of nail plate abnormalities by examining the inconsistency of internal and external nail plate structure, which can be diagnosed with both qualitative and quantitative assessments from a clinical perspective.
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Affiliation(s)
- Sm Abu Saleah
- grid.258803.40000 0001 0661 1556School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566 South Korea
| | - Pilun Kim
- grid.464630.30000 0001 0696 9566Production Engineering Research Institute, LG Electronics, 17790, 222 LG-ro Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do South Korea
| | - Daewoon Seong
- grid.258803.40000 0001 0661 1556School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566 South Korea
| | - Ruchire Eranga Wijesinghe
- grid.267198.30000 0001 1091 4496Department of Materials and Mechanical Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana, Homagama, 10200 Sri Lanka
| | - Mansik Jeon
- grid.258803.40000 0001 0661 1556School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566 South Korea
| | - Jeehyun Kim
- grid.258803.40000 0001 0661 1556School of Electronic and Electrical Engineering, College of IT Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566 South Korea
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25
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Chen L, Gao YH, Chen J, Yao YJ, Wang R, Yu Q, Hu B, Jiang LX. Diagnosis of Subungual Glomus Tumors with 18 MHz Ultrasound and CDFI. Sci Rep 2020; 10:17848. [PMID: 33082509 PMCID: PMC7575557 DOI: 10.1038/s41598-020-74774-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023] Open
Abstract
To evaluate the imaging features of subungual glomus tumors using 18 MHz high-frequency ultrasound with CDFI (Color Doppler Flow Imaging). 20 patients treated by surgical resection and examined by ultrasound between January 2008 and December 2019. All eligible cases are divided into two groups: Group A used the probe frequency of 9–14 MHz from January 2008 to December 2014, and Group B used the probe frequency of 18 MHz from January 2015 to December 2019. Patient demographics, clinical records, pathologic specimens and sonography features were reviewed. 50% of tumors in Group A and 100% of tumors in Group B showed clear boundary and regular shape. Blood flow signals were identified inside 50% tumors in Group A (3 in 6), all 14 cases with blood flow signals detected in Group B (14 in 14,100%). 2 cases were misdiagnosed and 1 case escaped diagnosis in Group A, no case was misdiagnosed in Group B. The accuracy of diagnosis rate of Group B is significantly higher than that of Group A. 18-MHz ultrasound combined with CDFI may be a practical useful tool for detecting subungual glomus tumors. More importantly 18-MHz ultrasound can obviously improve the diagnostic accuracy.
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Affiliation(s)
- Li Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yi-Hui Gao
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Jie Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yi-Jing Yao
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Rui Wang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Qian Yu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
| | - Li-Xin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
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26
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Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int 2020; 40:837-848. [PMID: 32211929 DOI: 10.1007/s00296-020-04559-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/14/2020] [Indexed: 01/08/2023]
Abstract
Many rheumatic diseases may present with an inflammatory joint syndrome, affecting the small joints of the hands, of which rheumatoid (RA) and psoriatic arthritis (PsA) being one of the most common. The aim of this systematic review was to focus on the literature evidence regarding the added value of ultrasound (US) of the hand in the differential diagnosis between RA and PsA. Pubmed and Scopus were searched to identify original manuscripts, published in the last 20 years utilising ultrasonography to reveal specific hand US patterns. Studies were eligible if they: (1) included adults (over 18 years) with a diagnosis of RA/PsA; (2) were published in the English language; (3) were published in peer-reviewed journals; (4) included description of the US machine; (5) used US for assessment of hand joints, periarticular tissues and nails. The search yielded 322 published studies, of which 16 were deemed relevant and were included in the present study. Overall, there was heterogeneity with regard to the pathology examined. Based on the included studies analysis, hand US patterns have several basic features to be considered-location of gray scale (GS) inflammatory findings, involvement of periarticular soft tissue, distribution and extent of Doppler signal (intra- and peri-articular), bone reaction, shape and location of erosions, involvement of tendons without synovial sheath, involvement of enthesis and nail abnormalities. Future research could focus on determining the sensitivity and specificity of the different US detected hand patterns in patients with early arthritis.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria. .,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria.
| | - Rositsa Karalilova
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
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Zheng X, Wu C, Jin H, Liu J, Wang H. Investigation of using very high-frequency ultrasound in the differential diagnosis of early-stage pemphigus vulgaris vs seborrheic dermatitis. Skin Res Technol 2020; 26:476-481. [PMID: 31930604 PMCID: PMC7496295 DOI: 10.1111/srt.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 12/05/2022]
Abstract
Background Early‐stage pemphigus vulgaris (PV) often manifests as erythema alone. We hypothesized that very high‐frequency ultrasonography (VHFUS) features could simplify the differential diagnosis of early‐stage pemphigus vulgaris versus seborrheic dermatitis (SD). Materials and Methods Fourteen patients with SD or early‐stage PV were recruited from our outpatient clinic during 2016‐2019. We used 50‐MHz VHFUS to image the erythema on the patients’ scalp, face, chest, and back and retrospectively evaluated their ultrasonographic features. Results Very high‐frequency ultrasonography images of early‐stage PV showed enhanced epidermal echo (8/14, 57%), linear or oval intra‐epidermal hypoechoic/anechoic areas (12/14, 86%), linear anechoic areas at the dermal‐epidermal junction (14/14, 100%), reduced echo of superficial to whole dermis (9/14, 64%), and slightly increased dermal thickness (14/14, 100%). The intra‐epidermal hypoechoic/anechoic bands (100%) showed the greatest specificity. VHFUS images of SD showed enhanced epidermal echo (7/14, 50%), epidermal unevenness (7/14, 50%), linear anechoic bands at the dermal‐epidermal junction (8/14, 57%), reduced middle dermis echo (10/14, 71%), and slightly increased dermal thickness (10/14, 71%). The epidermal unevenness (100%) had the greatest specificity. There was a significant difference (P < .05) between early‐stage PV and SD regarding the proportion of linear intraepithelial hypoechoic/anechoic bands and linear anechoic areas at the dermal‐epidermal junction. Conclusions Early‐stage PV and SD have relatively specific VHFUS erythematous manifestations. Intra‐epidermal hypoechoic/anechoic bands for early‐stage PV and epidermal unevenness for SD were most specific. VHFUS contributes to the differential diagnosis of PV and SD by highlighting their features, that is, intra‐epidermal hypoechoic/anechoic bands and linear anechoic areas at the dermal‐epidermal junction.
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Affiliation(s)
- Xiaofeng Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Wu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Liu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haimeng Wang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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28
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Mendonça JA, Aydin SZ, D’Agostino MA. The use of ultrasonography in the diagnosis of nail disease among patients with psoriasis and psoriatic arthritis: a systematic review. Adv Rheumatol 2019; 59:41. [DOI: 10.1186/s42358-019-0081-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 07/19/2019] [Indexed: 02/08/2023] Open
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29
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Fassio A, Giovannini I, Idolazzi L, Zabotti A, Iagnocco A, Sakellariou G. Nail ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Clin Rheumatol 2019; 39:1391-1404. [PMID: 31440917 DOI: 10.1007/s10067-019-04748-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 01/11/2023]
Abstract
To systematically review the role of ultrasound (US) in the assessment of the joint-enthesial-nail apparatus in patients with psoriatic arthritis (PsA) or psoriasis (PSO) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. A systematic literature review was conducted through medical databases (PubMed, Embase) and the grey literature up to February 2018. The main areas of application of nail US were first identified, allowing the development of research questions, which were rephrased following the PICOs methodology to develop inclusion criteria. Of the 585 studies produced by PubMed and Embase searches, 17 studies met the criteria for inclusion. Five additional studies were included: 1 from the hand search and 4 from the 2016-2017 ACR and EULAR congresses. The prevalence of nail plate changes varied from < 10 to 97%, for power Doppler signal from 20-30 to 96% and distal interphalangeal joint (DIJ) involvement from 8.9 to 100%. The performance of US nail/DIJ abnormalities in the diagnosis of PsA and PSO elementary lesions was analysed by five studies, with a wide heterogeneity. Reproducibility and reliability of US nil/DIJ were assessed by interclass correlation coefficient or Cohen's k and their values ranged from 0.6 to 0.9. The value of US nail/DIJ in the monitoring of the lesions was analysed only by a single study. The analysis revealed applications for US nail/DIJ in PsA and PSO and highlights limitations. Validation is strongly needed to demonstrate its appropriateness in the clinical practice and to define its diagnostic and prognostic role.
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Affiliation(s)
- A Fassio
- Rheumatology Unit, University of Verona, Piazzale A. Stefani 1, 137126, Verona, Italy
| | - I Giovannini
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - L Idolazzi
- Rheumatology Unit, University of Verona, Piazzale A. Stefani 1, 137126, Verona, Italy.
| | - A Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - A Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - G Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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30
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Krajewska-Włodarczyk M, Owczarczyk-Saczonek A, Placek W, Wojtkiewicz M, Wiktorowicz A, Wojtkiewicz J. Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis. Sci Rep 2019; 9:3628. [PMID: 30842536 PMCID: PMC6403314 DOI: 10.1038/s41598-019-39985-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/07/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.
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Affiliation(s)
- Magdalena Krajewska-Włodarczyk
- Department of Rheumatology, Municipal Hospital in Olsztyn, 10-900, Olsztyn, Poland. .,Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland. .,Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Waldemar Placek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Maja Wojtkiewicz
- Faculty of Earth Sciences, Department of Geomatics and Cartography Nicolaus Copernicus University, Torun, Poland.,DRAMIŃSKI S.A. Ultrasound Scanners, Olsztyn, Poland
| | | | - Joanna Wojtkiewicz
- Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.,Laboratory for Regenerative Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. The "green nail" phenomenon in ICG-enhanced fluorescence optical imaging - a potential tool for the differential diagnosis of psoriatic arthritis. J Dtsch Dermatol Ges 2019; 17:138-147. [PMID: 30702804 DOI: 10.1111/ddg.13747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of psoriatic arthritis poses a particular challenge. A novel fluorescence optical imaging technique, the Xiralite® system is very useful in this regard as it allows for visualization of microvasculature and perfusion. The present study is the first to systematically examine fluorescence optical signals in a large psoriatic arthritis cohort. PATIENTS AND METHODS In the primary study, we reviewed and analyzed extra-articular fluorescence optical signal patterns in 241 imaging sequences obtained from 187 psoriatic arthritis patients; 36 fluorescence optical sequences from 31 patients with rheumatoid arthritis served as controls. In a follow-up study, 203 consecutive fluorescence optical sequences from 54 psoriatic arthritis patients and 149 control subjects with various inflammatory rheumatic disorders were retrospectively evaluated in order to validate the primary study results in terms of the patterns previously identified. RESULTS Psoriatic arthritis patients exhibited three different fluorescence optical signal patterns in projection of the nails that have not been previously described. One of these patterns was the "green nail" sign, which was highly specific (97 %) for psoriatic arthritis. In the follow-up study, the specificity of this phenomenon in psoriatic arthritis was 87 % in comparison to the control cohort. CONCLUSIONS In the present study, fluorescence optical signals in the nail region proved to be highly specific for psoriatic arthritis. The "green nail" phenomenon seems to be of particular diagnostic interest as a potential sign of impaired microcirculation of the nail bed.
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Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Stephanie G Werner
- Department of Medicine III, Rheumatology, Helios St. Johannes Medical Center, Duisburg, Germany
| | - Hans-Eckhard Langer
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Marina Backhaus
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Weißensee Medical Center, Berlin, Germany
| | - René Chatelain
- Department of Dermatology and Allergology, Evangelical Hospital, Düsseldorf, and Faculty of Health, Department of Medicine, University of Witten/Herdecke, Germany
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. Phänomen „grüner Nagel“ in der ICG-gestützten fluoreszenzoptischen Bildgebung - ein möglicher differenzialdiagnostischer Hinweis auf Psoriasisarthritis. J Dtsch Dermatol Ges 2019; 17:138-148. [DOI: 10.1111/ddg.13747_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | | | - Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | - Marina Backhaus
- Abteilung für Innere Medizin - Rheumatologie und Klinische Immunologie Park-Klinik Weißensee; Berlin
| | - René Chatelain
- Klinik für Dermatologie und Allergologie; Evangelisches Krankenhaus Düsseldorf und Fakultät für Gesundheit; Department für Humanmedizin; Universität Witten/Herdecke
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Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis. J Clin Med 2018; 7:jcm7120546. [PMID: 30558114 PMCID: PMC6306839 DOI: 10.3390/jcm7120546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022] Open
Abstract
To assess the effect of methotrexate on the development of distal interphalangeal joint extensor tendon enthesopathy in psoriasis, thirty-two people aged 34 to 57 years with nail psoriasis and distal interphalangeal joint extensor tendon enthesopathy (19 patients with Ps (psoriasis) and 13 with PsA (psoriatic arthritis) were started on methotrexate at 15 to 25 mg/week and the treatment was continued for 6 months). A total of 319 nails were examined. After six months of treatment, the thicknesses of the nail plate, nail bed and nail matrix were found to decrease in both groups of patients. Methotrexate treatment resulted in a decrease in the joint extensor tendon thickness only in patients with Ps (0.94 ± 0.05 vs. 0.96 ± 0.04, p < 0.001), where the tendon thickness after treatment correlated with the matrix thickness (r = 0.337, p = 0.018) and with the bed thickness (r = 0.299, p = 0.039). Methotrexate treatment resulted in a decrease in the extensor tendon thickness only in patients with Ps but not in PsA. The findings of this study may suggest the effectiveness of systemic treatment of nail psoriasis in patients without arthritis and the use of US nail examinations in Ps and PsA patients in morphological change assessment and response to treatment.
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34
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To what extend is nail ultrasound discriminative between psoriasis, psoriatic arthritis and healthy subjects? Rheumatol Int 2018; 39:697-705. [DOI: 10.1007/s00296-018-4222-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/04/2018] [Indexed: 12/30/2022]
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Assessment of nail unit structures by ultrasound in patients with psoriatic arthritis and their correlations with disease activity indices: a case–control study. Rheumatol Int 2018; 38:2087-2093. [DOI: 10.1007/s00296-018-4160-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/12/2018] [Indexed: 10/27/2022]
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Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8251097. [PMID: 30271786 PMCID: PMC6151197 DOI: 10.1155/2018/8251097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
Aim of the Study The aim of the study was to conduct an ultrasound (US) assessment of changes in fingernails in psoriatic patients with nail involvement. Material A total of 69 patients with psoriatic changes in nails participated in the study, including 38 patients with psoriasis (Ps) and 31 with psoriatic arthritis (PsA) and 30 people in the control group. A total of 988 nails were examined. Results The thickness of the nail plate, nail bed, and matrix as shown in an ultrasound examination increased with the mNAPSI index (r=0.328, p=0.021; r=0.219, p=0.036; and r=0.422, p=0.011, respectively). The thickness of nail plate, bed, and matrix in patients with onycholysis and hyperkeratosis-type changes (concomitant or present separately) was significantly greater than when only pitting-type changes occurred (p=0.007, p=0.035, and p=0.023, respectively). An examination of nails with only pitting-type changes showed an increase in the matrix thickness compared to the control group (p=0.018). The focal hyperechoic involvement of the dorsal plate (80%) was the change most often observed in an US examination in Ps patients, whereas loosening of the borders of the ventral plate was most often observed in PsA patients. The thickness of nail bed in PsA patients increased with the duration of arthritis (r=0.399, p=0.022) and was correlated with the number of swollen digits (r=0.278, p=0.041). Conclusions The findings of this study may indicate an association of an inflammation in the nail bed with PsA development. Apart from a direct assessment of the described morphological changes of nails, a US examination could prove useful in an assessment of intensity of a local inflammation as a prognostic factor for PsA development.
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Jacobson JA, Roberts CC, Bencardino JT, Appel M, Arnold E, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Gyftopoulos S, Hochman MG, Mintz DN, Newman JS, Rosenberg ZS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria ® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis. J Am Coll Radiol 2018; 14:S81-S89. [PMID: 28473097 DOI: 10.1016/j.jacr.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 02/07/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jon A Jacobson
- Principal Author, University of Michigan Medical Center, Ann Arbor, Michigan.
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons
| | - Erin Arnold
- Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois. American College of Rheumatology
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky. American Academy of Orthopaedic Surgeons
| | - Eric Y Chang
- VA San Diego Healthcare System, San Diego, California
| | - Michael G Fox
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Mary G Hochman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
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Vidal D, Alfageme F, Ruiz-Villaverde R, Arias-Santiago S, Martorell A. Caracterización ecográfica de la psoriasis ungueal: estudio de casos y controles. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:968-969. [DOI: 10.1016/j.ad.2017.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/17/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
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Vidal D, Alfageme F, Ruiz-Villaverde R, Arias-Santiago S, Martorell A. Ultrasound Characterization of Psoriasis of the Nails: A Case-Control Study. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cunha JS, Amorese-O’Connell L, Gutierrez M, Qureshi AA, Reginato AM. Ultrasound Imaging of Nails in Psoriasis and Psoriatic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0067-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cunha JS, Qureshi AA, Reginato AM. Nail Enthesis Ultrasound in Psoriasis and Psoriatic Arthritis: A Report from the 2016 GRAPPA Annual Meeting. J Rheumatol 2017; 44:688-690. [DOI: 10.3899/jrheum.170146] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Musculoskeletal ultrasonography is gaining favor in the evaluation of enthesitis in patients with psoriasis and psoriatic arthritis (PsA). Imaging modalities have shown that the enthesis of the distal interphalangeal joint has a close relationship to the nail itself. Studies have focused on the structure and morphology of nails to determine an association between psoriasis nail changes and the presence or severity of PsA. With the use of higher frequency probes, power Doppler (PD) can determine subclinical inflammation of the area under ultrasound examination. At the 2016 meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we proposed an ultrasonographic index for the assessment of the nail enthesis to identify the morphologic and PD findings of the nail, with the potential that both rheumatologists and dermatologists can use it to evaluate their patients.
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Gutierrez M, Kaeley GS, Bertolazzi C, Pineda C. State of the art of ultrasound in the assessment of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2016; 13:439-447. [DOI: 10.1080/1744666x.2017.1262765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Gurjit S Kaeley
- College of Medicine, University of Florida, Jacksonville, USA
| | - Chiara Bertolazzi
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
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Arbault A, Devilliers H, Laroche D, Cayot A, Vabres P, Maillefert JF, Ornetti P. Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis. Joint Bone Spine 2016; 83:539-44. [DOI: 10.1016/j.jbspin.2015.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 02/04/2023]
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Mathew AJ, Coates LC, Danda D, Conaghan PG. Psoriatic arthritis: lessons from imaging studies and implications for therapy. Expert Rev Clin Immunol 2016; 13:133-142. [DOI: 10.1080/1744666x.2016.1215245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ashish J. Mathew
- Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Laura C. Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Debashish Danda
- Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Ultrasonographic characterization of the nails in patients with psoriasis and onychomycosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ultrasound in psoriatic arthritis. Can it facilitate a best routine practice in the diagnosis and management of psoriatic arthritis? Clin Rheumatol 2015; 34:1847-55. [DOI: 10.1007/s10067-015-3053-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
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Ultrasound in musculoskeletal disorder – A new horizon in rheumatology. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Eder L, Tillett W, Ritchlin CT. GRAPPA Trainees Symposium 2014: A Report from the GRAPPA 2014 Annual Meeting. J Rheumatol 2015. [DOI: 10.3899/jrheum.150122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The seventh trainees symposium was held at the 2014 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in New York, New York, USA. A total of 26 rheumatology and dermatology trainees engaged in psoriasis or psoriatic arthritis research presented their work to meeting attendees. This article briefly reviews the 4 oral presentations and 22 posters presented at the meeting.
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Sandre MK, Rohekar S, Guenther L. Psoriatic Nail Changes Are Associated With Clinical Outcomes in Psoriatic Arthritis. J Cutan Med Surg 2015; 19:367-76. [PMID: 25775610 DOI: 10.1177/1203475415573663] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nail changes are common in psoriatic arthritis (PsA), with varying relationships existing between skin, nail, and joint disease. OBJECTIVE To further characterize relationships between nail changes, psoriasis, and joint involvement in PsA patients. METHODS One hundred eighty-eight PsA patients had skin, fingernail, and rheumatological assessments completed. Hand and fingernail photographs were taken and reviewed by a dermatologist. RESULTS Higher swollen joint counts were associated with distal interphalangeal (DIP)/periungual psoriasis (P=.001), more splinter hemorrhages (P=.006), and any nail bed change (P=.03). Higher tender joint counts were associated with rough onychorrhexis (P<.001), DIP/periungual psoriasis (P=.03), red lunula (P=.001), nail crumbling (P=.046), any nail matrix (P=.03), and nail bed change (P=.03). Joint involvement was associated with same-digit nail changes; strongest association was swollen or tender DIP with subungual hyperkeratosis, odds ratio=26.6 (95% CI, 5.1-139.1). CONCLUSION The DIP/periungual psoriasis and specific nail changes were associated with higher joint counts and certain nail changes with same-digit joint involvement.
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Affiliation(s)
| | - Sherry Rohekar
- St. Joseph's Hospital, London, ON, Canada Schulich School of Medicine, London, ON, Canada
| | - Lyn Guenther
- Schulich School of Medicine, London, ON, Canada Guenther Dermatology Research Centre, London, ON, Canada
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