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.
TaylorWGladmanDHelliwellPMarchesoniAMeasePMielantsH. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665-2673.
2.
ConaghanPGCoatesLC. Improving recognition of psoriatic arthritis. Practitioner. 2009;253(1724):15-18.
3.
GladmanDDMeasePJStrandV. Consensus on a core set of domains for psoriatic arthritis. J Rheumatol. 2007;34(5):1167-1170.
4.
GladmanDDChandranVThavaneswaranAZummerM. Psoriatic arthritis in Canadian clinical practice: the PsA assessment in rheumatology. J Rheumatol. 2012;39(9).
5.
JamshidiFBouzariNSeirafiHFarnaghiFFiroozA. The prevalence of psoriatic arthritis in psoriatic patients in Tehran, Iran. Arch Iran Med. 2008;11(2):162-165.
6.
de JongEMSeegersBAGulinckMKBoezemanJBvan de KerkhofPC. Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients. Dermatology. 1996;193(4):300-303.
7.
de BerkerD. Management of psoriatic nail disease. Semin Cutan Med Surg. 2009;28(1):39-43.
8.
ShemerADanielCRIII. Common nail disorders. Clin Dermatol. 2013;31(5):578-586.
9.
OmuraEF. Histopathology of the nail. Dermatol Clin. 1985;3(3):531-541.
10.
JiaravuthisanMMSassevilleDVenderRBMurphyFMuhnCY. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57(1):1-27.
11.
SalomonJSzepietowskiJCProniewiczA. Psoriatic nails: a prospective clinical study. J Cutan Med Surg. 2003;7(4):317-321.
12.
SteeleGEmerJLarianA. The treatment of nail psoriasis: a review. Psoriasis Forum. 2011;17(3):188-199.
13.
McGonagleD. Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. J Eur Acad Dermatol Venereol. 2009;23(suppl 1):9-13.
14.
DonckerPDPierardGE. Acquired nail beading in patients receiving itraconazole—an indicator of faster nail growth? A study using optical profilometry. Clin Exp Dermatol. 1994;19(5):404-406.
15.
MorrisseyKARubinAI. Histopathology of the red lunula: new histologic features and clinical correlations of a rare type of erythronychia. J Cutan Pathol. 2013;40(11):972-975.
16.
ScarpaRSosciaEPelusoR A. Nail and distal interphalangeal joint in psoriatic arthritis. J Rheumatol. 2006;33(7):1315-1319.
17.
Torre AlonsoJCRodriguez PerezAArribas CastrilloJMBallina GarciaJRiestra NoriegaJLLopez LarreaC. Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Br J Rheumatol. 1991;30(4):245-250.
18.
LoveTJGudjonssonJEValdimarssonHGudbjornssonB. Small joint involvement in psoriatic arthritis is associated with onycholysis: the Reykjavik Psoriatic Arthritis Study. Scand J Rheumatol. 2010;39(4):299-302.
19.
TanALBenjaminMToumiH. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis—a high-resolution MRI and histological study. Rheumatology (Oxford). 2007;46(2):253-256.
20.
MaejimaHTaniguchiTWataraiAKatsuokaK. Evaluation of nail disease in psoriatic arthritis by using a modified nail psoriasis severity score index. Int J Dermatol. 2010;49(8):901-906.
21.
LoveTJGudjonssonJEValdimarssonHGudbjornssonB. Psoriatic arthritis and onycholysis—results from the cross-sectional reykjavik psoriatic arthritis Study. J Rheumatol. 2012;39(7):1441-1444.
22.
CassellSEBieberJDRichP. The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis. J Rheumatol. 2007;34(1):123-129.
23.
WilliamsonLDalbethNDockertyJLGeeBCWeatherallRWordsworthBP. Extended report: nail disease in psoriatic arthritis—clinically important, potentially treatable and often overlooked. Rheumatology (Oxford). 2004;43(6):790-794.
24.
ZisovaLValtchevVSotiriouEGospodinovDMateevG. Onychomycosis in patients with psoriasis—a multicentre study. Mycoses. 2012;55(2):143-147.
25.
SandreMKRohekarS. Psoriatic arthritis and nail changes: exploring the relationship. Semin Arthritis Rheu. 2014;44(2):162-169.
26.
BakerHGoldingDNThompsonM. The nails in psoriatic arthritis. Br J Dermatol. 1964;76:549-554.
27.
EastmondCJWrightV. The nail dystrophy of psoriatic arthritis. Ann Rheum Dis. 1979;38(3):226-228.
28.
SoyMKaracaNUmitEUBesCPiskinS. Joint and nail involvement in Turkish patients with psoriatic arthritis. Rheumatol Int. 2008;29(2):223-225.
29.
HamiltonEB. Nail studies in rheumatoid arthritis. Ann Rheum Dis. 1960;19:167-173.
30.
GrantENBellamyNBuchananWWGraceEMO’LearyS. Statistical reappraisal of the clinical significance of nail beading in rheumatoid arthritis. Ann Rheum Dis. 1985;44(10):671-675.
31.
CashmanMWSloanSB. Nutrition and nail disease. Clin Dermatol. 2010;28(4):420-425.
32.
van de KerkhofPCPaschMCScherRK. Brittle nail syndrome: a pathogenesis-based approach with a proposed grading system. J Am Acad Dermatol. 2005;53(4):644-651.
33.
El-DomyatiMAbdel-WahabHAbdel-AzimE. Nail changes and disorders in elderly Egyptians. J Cosmet Dermatol. 2014;13(4):269-276.
34.
GequelimGCKubotaCYSanchesS. Perception of brittle nails in dermatologic patients: a cross-sectional study. An Bras Dermatol. 2013;88(6):1022-1025.
35.
LubachDCohrsWWurzingerR. Incidence of brittle nails. Dermatologica. 1986;172(3):144-147.
36.
SandobalCCarboEIribasJRoveranoSPairaS. Ultrasound nail imaging on patients with psoriasis and psoriatic arthritis compared with rheumatoid arthritis and control subjects. J Clin Rheumatol. 2014;20(1):21-24.
37.
TanALGraingerAJTannerSFEmeryPMcGonagleD. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same?Arthritis Rheum. 2006;54(4):1328-1333.
38.
McGonagleDTanALBenjaminM. The nail as a musculoskeletal appendage—implications for an improved understanding of the link between psoriasis and arthritis. Dermatology. 2009;218(2):97-102.
39.
McGonagleDTanALBenjaminM. The biomechanical link between skin and joint disease in psoriasis and psoriatic arthritis: what every dermatologist needs to know. Ann Rheum Dis. 2008;67(1):1-4.
40.
ChandranVO’SheaFDSchentagCTInmanRDGladmanDD. Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis. J Rheumatol. 2007;34(12):2463-2465.
41.
Fernandez-SueiroJLWillischAPertega-DiazS. Evaluation of ankylosing spondylitis spinal mobility measurements in the assessment of spinal involvement in psoriatic arthritis. Arthritis Rheum. 2009;61(3):386-392.
42.
LeungYYHoKWTamLS. Evaluation of spinal mobility measurements in predicting axial psoriatic arthritis. Clin Rheumatol. 2011;30(9):1157-1162.
43.
KlaassenKMvan de KerkhofPCBastiaensMTPlusjeLGBaranRLPaschMC. Scoring nail psoriasis. J Am Acad Dermatol. 2014;70(6):1061-1066.
44.
van der VeldenHMKlaassenKMvan de KerkhofPCPaschMC. Fingernail psoriasis reconsidered: a case-control study. J Am Acad Dermatol. 2013;69(2):245-252.
45.
ChandranVGottliebACookRJ. International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis. Arthritis Rheum. 2009;61(9):1235-1242.
46.
GladmanDDCookRJSchentagC. The clinical assessment of patients with psoriatic arthritis: results of a reliability study of the spondyloarthritis research consortium of Canada. J Rheumatol. 2004;31(6):1126-1131.
47.
GladmanDDInmanRDCookRJ. International spondyloarthritis interobserver reliability exercise—the INSPIRE study: I. Assessment of spinal measures. J Rheumatol. 2007;34(8):1733-1739.
