Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study

Maria Esposito; Lina Maria Magnanimi; Paolo Antonetti; Andrea  De Berardinis; Cristina Pellegrini; Emanuele Vagnozzi; Manfredo Bruni; Camilla Gianneramo; Paola Cipriani; Maria Concetta Fargnoli; Antonio Barile; Piero Ruscitti

doi:10.5826/dpc.1503a5318

Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study

Authors

Maria Esposito Biotechnological and Applied Clinical Sciences - University of L'Aquila
Lina Maria Magnanimi Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy https://orcid.org/0000-0003-2056-9483
Paolo Antonetti Dermatology Unit, San Salvatore Hospital, L’Aquila, Italy
Andrea De Berardinis Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Cristina Pellegrini Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Emanuele Vagnozzi Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Manfredo Bruni Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy https://orcid.org/0000-0001-9357-9653
Camilla Gianneramo Department of Emergency and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
Paola Cipriani Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Maria Concetta Fargnoli Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Antonio Barile Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Piero Ruscitti Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

Keywords:

nail psoriasis , High Frequency Ultrasound, Psoriatic Arthritis, Psoriasis Diagnosis

Abstract

Introduction: In patients with plaque type psoriasis (PSO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PSO patients with a wide spectrum of clinical features and is a significant predictor of enthesitis, often associated with early PsA stages.

Objective: This study aimed to clinically and ultrasonographically evaluate nail units in PSO patients, focusing on differences between those with/without PsA and those with/without onychopathy.

Methods: Sixty patients were enrolled (23/60 PSO-37/60 PSO and PsA). PSO and PsA patients were evaluated and compared as well as patients with/without diagnosis of nail psoriasis in this cross-sectional single-center study. Nail abnormalities were evaluated by high frequency ultrasound (HFUS) using high frequency probes (27 MHz). After a descriptive assessment, the Nail Psoriasis Severity Index (NAPSI) and the Brown University Nail Enthesis Scale (BUNES) were used to clinically and ultrasonographically assess nails.

Results: HFUS evaluation identified a spectrum of nail and blood flow alterations. Nail disease was characterized by median NAPSI 16 (range 28), median BUNES morphometry 1.5 (range 0.9), and median BUNES power Doppler (PD) 2.2 (range 4.03). Among the studied sample, 43/60 (71.7%) presented nail psoriasis, with 69.7% presenting coexisting PsA as compared to PSO patients (30.3%) (p = 0.04).

Conclusion: Our findings highlight the importance of close collaboration between dermatologists and rheumatologists in the evaluation of PSO patients, taking advantage of both clinical and ultrasonographic assessment of nail damage.

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