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To what extend is nail ultrasound discriminative between psoriasis, psoriatic arthritis and healthy subjects?

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Abstract

To assess the discriminative utility of nail features detected by B-mode (BM) and color Doppler (CD) ultrasound (US) between patients with psoriasis (PsO) and psoriatic arthritis (PsA) and healthy controls. Sixty patients with PsA, 21 patients with PsO, and 20 healthy controls were prospectively included. All patients underwent a dermatologic assessment and PsA patients also a rheumatologic assessment. All patients and controls underwent a US assessment of the finger nails that included a BM score for nail plate integrity and four different CD scores based on the amount and location of CD signals in the nail bed/matrix. In addition, we measured the thickness of the nail bed (TNB) and nail plate (TNP). The BM score and the CD score based on the amount of signals in the nail bed in contact with the ventral plate discriminated between the control group (median, range 0.0, 0–4 and 2.0, 0–9, respectively) and the PsO/PsA group (median, range: 7.0, 0–31 and 5.14, 0–13, respectively) (p < 0.05) with or without clinical nail involvement. The CD scores based on the percentage of the nail bed/matrix occupied by Doppler signals did not discriminate between controls and PsO/PsA patients. TNB and TNP were significantly higher in psoriatic nails with or without clinical involvement than in control nails. In PsO/PsA patients, the BM score, TNB and TNP were significantly higher in clinically involved nail than in clinically non-involved nails. Our results showed discriminative utility of BM US and some CD US features for PsO/PsA nails.

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Funding

This work was supported by UCB Pharma through a publication Grant, and underwent courtesy review by UCB Pharma.

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Authors and Affiliations

  1. Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain

    Esperanza Naredo

  2. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Iustina Janta, Natalia Bello & Belén Serrano

  3. Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Ofelia Baniandrés-Rodríguez

  4. Rheumatology and Clinical Immunology Department, Universitätsklinikum Erlangen-Nürnberg, Erlangen, Germany

    Lara Valor

  5. Department of Internal Medicine and Rheumatology, Hospital Helios Klinikum Berlin-Buch, Berlin, Germany

    Michelle Hinojosa

  6. Department of Social Psychology and Methodology, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain

    Jesús Garrido

Authors
  1. Esperanza Naredo
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  2. Iustina Janta
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  3. Ofelia Baniandrés-Rodríguez
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  4. Lara Valor
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  5. Michelle Hinojosa
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  6. Natalia Bello
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  7. Belén Serrano
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  8. Jesús Garrido
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Contributions

Study design: EN. Acquisition of data: IJ, OBR, LV, MH, NB, BS, and EN. Analysis and interpretation of data: EN and JG. Manuscript drafting: EN, IJ, and JG. Manuscript revision and approval: IJ, OBR, LV, MH, NB, BS, JG, and EN.

Corresponding author

Correspondence to Esperanza Naredo.

Ethics declarations

Conflict of interest

Esperanza Naredo, Iustina Janta, Ofelia Baniandres-Rodriguez, Lara Valor, Michelle Hinojosa, Natalia Bello, Belén Serrano, and Jesús Garrido declare that they have no conflict of interest relating to the topic.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 KB)

296_2018_4222_MOESM2_ESM.jpg

Supplementary Fig 1. B-mode score, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Normal aspect of the dorsal and ventral palates (BM-Sc=0). b). Involvement of the ventral plate only at the matrix level (BM-Sc=1). c). Involvement of the whole ventral plate (BM-Sc=2). d). Involvement of the both plates (BM-Sc=3). e). Complete loss of the normal structure (BM-Sc=4). (JPG 16 KB)

Supplementary material 3 (JPG 16 KB)

Supplementary material 4 (JPG 19 KB)

Supplementary material 5 (JPG 15 KB)

296_2018_4222_MOESM6_ESM.jpg

Supplementary Fig 1. B-mode score, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Normal aspect of the dorsal and ventral palates (BM-Sc=0). b). Involvement of the ventral plate only at the matrix level (BM-Sc=1). c). Involvement of the whole ventral plate (BM-Sc=2). d). Involvement of the both plates (BM-Sc=3). e). Complete loss of the normal structure (BM-Sc=4). (JPG 16 KB)

296_2018_4222_MOESM7_ESM.jpg

Supplementary Fig 2. CD score 1, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Isolated Doppler spots (CD-Sc1=0). b). Doppler signals occupying less than 50% of the nail matrix/bed area (CD-Sc1=1). c). Doppler signals occupying more than 50% of the nail matrix/bed area (CD-Sc1=2) (JPG 11 KB)

Supplementary material 7 (JPG 19 KB)

Supplementary material 8 (JPG 23 KB)

296_2018_4222_MOESM10_ESM.jpg

Supplementary Fig 3. CD score 2, longitudinal view of the nail; dp, distal phalange; nb, nail bed. a). Doppler signals without contact with the ventral plate (CD-Sc2=0). b). Doppler signals with isolated focal contact with the ventral plate (CD-Sc2=1). c). Doppler signals with diffuse contact with the ventral plate (CD-Sc2=2). (JPG 20 KB)

Supplementary material 10 (JPG 16 KB)

Supplementary material 11 (BMP 172 KB)

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Naredo, E., Janta, I., Baniandrés-Rodríguez, O. et al. To what extend is nail ultrasound discriminative between psoriasis, psoriatic arthritis and healthy subjects?. Rheumatol Int 39, 697–705 (2019). https://doi.org/10.1007/s00296-018-4222-y

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  • DOI: https://doi.org/10.1007/s00296-018-4222-y

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