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Subclinical enthesitis in nail psoriasis patients: a case-control study
Karlijn M G Klaassen1, Marieke J M Ploegmakers2, Peter C M van de Kerkhof1
1Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Summary
Nail psoriasis patients show subclinical enthesitis at the distal interphalangeal joint. However, this study did not confirm an anatomical link between nail psoriasis and psoriatic arthritis.
Area of Science:
- Dermatology and Rheumatology
- Musculoskeletal Imaging
- Psoriatic Disease Pathogenesis
Background:
- Nail psoriasis is associated with a higher prevalence of psoriatic arthritis, but the exact pathogenetic link remains unclear.
- Entheses, particularly at the distal interphalangeal (DIP) joint, are hypothesized as a potential anatomical epicenter for disease development.
Purpose of the Study:
- To investigate the hypothesis of an anatomical connection between nail psoriasis and psoriatic arthritis.
- To examine the extensor enthesis of the DIP joint as a potential epicenter in patients with nail psoriasis.
Main Methods:
- A cross-sectional cohort study involving 3D ultrasound of DIP joint entheses.
- Included patients with fingernail psoriasis (n=54), psoriasis without nail involvement (n=32), and healthy controls (n=32).
- Repeat imaging after one year for patients with nail psoriasis.
Main Results:
- Nail psoriasis patients exhibited significantly thicker radial entheses compared to psoriasis patients without nail involvement.
- No significant difference in entheseal thickness was observed between affected and unaffected adjacent nails.
- One-year follow-up revealed no significant changes in entheseal thickness related to nail psoriasis activity.
Conclusions:
- The study provides evidence for subclinical enthesitis at the DIP joint level in individuals with nail psoriasis.
- An anatomical correlation between nail psoriasis and psoriatic arthritis could not be established in this cohort.