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Updated: Apr 16, 2026

Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Psoriatic Nail Changes Are Associated With Clinical Outcomes in Psoriatic Arthritis
Matthew K Sandre1, Sherry Rohekar2, Lyn Guenther3
1Michael G. DeGroote School of Medicine, Hamilton, ON, Canada matthew.sandre@medportal.ca.
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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