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Nail ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review

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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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References

  1. Jiaravuthisan MM, Sasseville D, Vender RB, Murphy F, Muhn CY (2007) Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol 57:1–27. https://doi.org/10.1016/j.jaad.2005.07.073

    Article  PubMed  Google Scholar 

  2. Haneke E (2015) Anatomy of the nail unit and the nail biopsy. Semin Cutan Med Surg 34:95–100. https://doi.org/10.12788/j.sder.2015.0143

    Article  PubMed  Google Scholar 

  3. Schons KRR, Knob CF, Murussi N, Beber AAC, Neumaier W, Monticielo OA (2014) Nail psoriasis: a review of the literature. An Bras Dermatol 89:312–317

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rich P, Scher RK (2003) Nail psoriasis severity index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol 49:206–212

    Article  PubMed  Google Scholar 

  5. Nestle FO, Kaplan DH, Barker J (2009) Psoriasis. N Engl J Med 361:496–509. https://doi.org/10.1056/NEJMra0804595

    Article  CAS  PubMed  Google Scholar 

  6. Watad A, Cuthbert RJ, Amital H, McGonagle D (2018) Enthesitis: much more than focal insertion point inflammation. Curr Rheumatol Rep 20(41):41. https://doi.org/10.1007/s11926-018-0751-3

    Article  PubMed  PubMed Central  Google Scholar 

  7. Acosta-Felquer ML, Ruta S, Rosa J, Marin J, Ferreyra-Garrot L, Galimberti ML, Galimberti R, Garcia-Monaco R, Soriano ER (2017) Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory. Semin Arthritis Rheum 47:338–342. https://doi.org/10.1016/j.semarthrit.2017.05.002

    Article  PubMed  Google Scholar 

  8. Batticciotto A, Idolazzi L, De Lucia O et al (2017) Could nail and joint alterations make the difference between psoriatic arthritis and osteoarthritis during the ultrasonographic evaluation of the distal interphalangeal joints? Med Ultrason 19:347–348

    Article  PubMed  Google Scholar 

  9. Lai TL, Pang HT, Cheuk YY, Yip ML (2016) Psoriatic nail involvement and its relationship with distal interphalangeal joint disease. Clin Rheumatol 35:2031–2037. https://doi.org/10.1007/s10067-016-3319-5

    Article  CAS  PubMed  Google Scholar 

  10. Gutierrez M, Kaeley GS, Bertolazzi C, Pineda C (2017) State of the art of ultrasound in the assessment of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 13:439–447. https://doi.org/10.1080/1744666X.2017.1262765

    Article  CAS  PubMed  Google Scholar 

  11. Tan AL, Benjamin M, Toumi H, Grainger AJ, Tanner SF, Emery P, McGonagle D (2007) 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. Rheumatol (Oxf Engl) 46:253–256. https://doi.org/10.1093/rheumatology/kel214

    Article  CAS  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  13. Deeks JJ, Dinnes J, D’Amico R et al (2003) Evaluating non-randomised intervention studies. Health Technol Assess (Winch Eng) 7:iii–iix 1–173

    CAS  Google Scholar 

  14. Acquitter M, Misery L, Saraux A, Bressollette L, Jousse-Joulin S (2017) Detection of subclinical ultrasound enthesopathy and nail disease in patients at risk of psoriatic arthritis. Joint Bone Spine 84:703–707. https://doi.org/10.1016/j.jbspin.2016.10.005

    Article  PubMed  Google Scholar 

  15. Marina ME, Solomon C, Bolboaca S-D et al (2016) High-frequency sonography in the evaluation of nail psoriasis. Med Ultrason 18:312–317

    Article  PubMed  Google Scholar 

  16. Castellanos-González M, Joven BE, Sánchez J, Andrés-Esteban EM, Vanaclocha-Sebastián F, Romero PO, Díaz RR (2016) Nail involvement can predict enthesopathy in patients with psoriasis. J Dtsch Dermatol Ges J Ger Soc Dermatol 14:1102–1107. https://doi.org/10.1111/ddg.12989

    Article  Google Scholar 

  17. Aydin SZ, Castillo-Gallego C, Ash ZR, Abignano G, Marzo-Ortega H, Wittmann M, del Galdo F, McGonagle D (2013) Potential use of optical coherence tomography and high-frequency ultrasound for the assessment of nail disease in psoriasis and psoriatic arthritis. Dermatology (Basel Switz) 227:45–51. https://doi.org/10.1159/000351702

    Article  Google Scholar 

  18. Ash ZR, Tinazzi I, Gallego CC, Kwok C, Wilson C, Goodfield M, Gisondi P, Tan AL, Marzo-Ortega H, Emery P, Wakefield RJ, McGonagle DG, Aydin SZ (2012) Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails. Ann Rheum Dis 71:553–556. https://doi.org/10.1136/annrheumdis-2011-200478

    Article  PubMed  Google Scholar 

  19. Rodriguez Henriquez P, Cardenas-Hernandez ML, Lammoglia-Ordiales L et al (2017) AB0782 (2017) psoriatic arthritis early ultrasonographic changes in patients with psoriasis and nail psoriasis. A comparative study with subjects without psoriasis. Ann Rheum Dis 76:1330. https://doi.org/10.1136/annrheumdis-2017-eular.5552

    Article  Google Scholar 

  20. Arbault A, Devilliers H, Laroche D, Cayot A, Vabres P, Maillefert JF, Ornetti P (2016) Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis. Joint Bone Spine Rev Rhum 83:539–544. https://doi.org/10.1016/j.jbspin.2015.11.004

    Article  Google Scholar 

  21. Aydin SZ, Castillo-Gallego C, Ash ZR et al (2017) Vascularity of nail bed by ultrasound to discriminate psoriasis, psoriatic arthritis and healthy controls. Clin Exp Rheumatol 35:872

    PubMed  Google Scholar 

  22. Paramalingam S, Taylor A, Keen H (2017) FRI0672 assessment of the nail bed in psoriatic arthritis (PSA) by ultrasound (US) and MRI. Ann Rheum Dis 76:744. https://doi.org/10.1136/annrheumdis-2017-eular.5614

    Article  Google Scholar 

  23. Ally Essayed SM, Al-Shatouri MA, Nasr Allah YS, Atwa MA (2015) Ultrasonographic characterization of the nails in patients with psoriasis and onychomycosis. Egypt J Radiol Nucl Med 46:733–739. https://doi.org/10.1016/j.ejrnm.2015.04.009

    Article  Google Scholar 

  24. El Miedany Y, El Gaafary M, Youssef S et al (2015) Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage. Clin Rheumatol 34:307–313. https://doi.org/10.1007/s10067-014-2630-2

    Article  PubMed  Google Scholar 

  25. Sandobal C, Carbó E, Iribas J, Roverano S, Paira S (2014) Ultrasound nail imaging on patients with psoriasis and psoriatic arthritis compared with rheumatoid arthritis and control subjects. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 20:21–24. https://doi.org/10.1097/RHU.0000000000000054

    Article  Google Scholar 

  26. Bandinelli F, Denaro V, Prignano F, Collaku L, Ciancio G, Matucci-Cerinic M (2015) Ultrasonographic wrist and hand abnormalities in early psoriatic arthritis patients: correlation with clinical, dermatological, serological and genetic indices. Clin Exp Rheumatol 33:330–335

    PubMed  Google Scholar 

  27. Idolazzi L, Gisondi P, Fassio A, Viapiana O, Giollo A, Rossini M, Girolomoni G, Gatti D (2018) Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis. Med Ultrason 20:177–184

    Article  PubMed  Google Scholar 

  28. Nascimento de Carvalho Klemz B, Luz K, Maria Damasio Ohe E, Maria Porro A. Subclinical ungueal distrophy in patients with psoriasis without joint involvement: is there any role for nail ultrasound? In: ACR 2016 Meet. Abstr. https://acrabstracts.org/abstract/subclinical-ungueal-distrophy-in-patients-with-psoriasis-without-joint-involvement-is-there-any-role-for-nail-ultrasound/. Accessed 17 Feb 2019

  29. Aydin SZ, Castillo-Gallego C, Ash ZR, Marzo-Ortega H, Emery P, Wakefield RJ, Wittmann M, McGonagle D (2012) Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy. Dermatology 225:231–235. https://doi.org/10.1159/000343607

    Article  PubMed  Google Scholar 

  30. Subclinical Ungueal Distrophy in patients with psoriasis without joint involvement: is there any role for nail ultrasound? In: ACR Meet. Abstr. http://acrabstracts.org/abstract/subclinical-ungueal-distrophy-in-patients-with-psoriasis-without-joint-involvement-is-there-any-role-for-nail-ultrasound/. Accessed 27 Mar 2018

  31. Husein El-Ahmed H, Garrido-Pareja F, Ruiz-Carrascosa J-C, Naranjo-Sintes R (2012) Vessel resistance to blood flow in the nailfold in patients with psoriasis: a prospective case-control echo Doppler-based study. Br J Dermatol 166:54–58. https://doi.org/10.1111/j.1365-2133.2011.10579.x

    Article  CAS  PubMed  Google Scholar 

  32. Janta I, Baniandres Rodriguez O, Valor L et al (2017) AB1029 ultrasound nail assessment in psoriatic arthritis and psoriasis compared with healthy controls. 76:1414. https://doi.org/10.1136/annrheumdis-2017-eular.4126

  33. Klaassen KMG, Ploegmakers MJM, van de Kerkhof PCM, Klein WM, Pasch MC (2017) Subclinical enthesitis in nail psoriasis patients: a case-control study. J Dtsch Dermatol Ges J Ger Soc Dermatol 15:405–412. https://doi.org/10.1111/ddg.13222

    Article  Google Scholar 

  34. Gutierrez M, Di Geso L, Salaffi F et al (2012) Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxf Eng) 51:1261–1268. https://doi.org/10.1093/rheumatology/kes014

    Article  Google Scholar 

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Authors and Affiliations

  1. Rheumatology Unit, University of Verona, Piazzale A. Stefani 1, 137126, Verona, Italy

    A. Fassio & L. Idolazzi

  2. Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy

    I. Giovannini & A. Zabotti

  3. Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy

    A. Iagnocco

  4. Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy

    G. Sakellariou

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Correspondence to L. Idolazzi.

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Fassio, A., Giovannini, I., Idolazzi, L. et al. Nail ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Clin Rheumatol 39, 1391–1404 (2020). https://doi.org/10.1007/s10067-019-04748-2

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  • DOI: https://doi.org/10.1007/s10067-019-04748-2

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