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Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease.
J Eur Acad Dermatol Venereol. 2018 Oct; 32(10):1728-1736.JE

Abstract

BACKGROUND

Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered.

OBJECTIVE

To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA.

METHODS

Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand.

RESULTS

Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368).

CONCLUSION

Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

Authors+Show Affiliations

Rheumatology Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Rheumatology Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29706002

Citation

Moya Alvarado, P, et al. "Subclinical Enthesopathy of Extensor Digitorum Tendon Is Highly Prevalent and Associated With Clinical and Ultrasound Alterations of the Adjacent Fingernails in Patients With Psoriatic Disease." Journal of the European Academy of Dermatology and Venereology : JEADV, vol. 32, no. 10, 2018, pp. 1728-1736.
Moya Alvarado P, Roé Crespo E, Muñoz-Garza FZ, et al. Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease. J Eur Acad Dermatol Venereol. 2018;32(10):1728-1736.
Moya Alvarado, P., Roé Crespo, E., Muñoz-Garza, F. Z., López-Ferrer, A., Laiz Alonso, A., Vilarrassa Rull, E., Casademont I Pou, J., & Puig Sanz, L. (2018). Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease. Journal of the European Academy of Dermatology and Venereology : JEADV, 32(10), 1728-1736. https://doi.org/10.1111/jdv.15035
Moya Alvarado P, et al. Subclinical Enthesopathy of Extensor Digitorum Tendon Is Highly Prevalent and Associated With Clinical and Ultrasound Alterations of the Adjacent Fingernails in Patients With Psoriatic Disease. J Eur Acad Dermatol Venereol. 2018;32(10):1728-1736. PubMed PMID: 29706002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease. AU - Moya Alvarado,P, AU - Roé Crespo,E, AU - Muñoz-Garza,F Z, AU - López-Ferrer,A, AU - Laiz Alonso,A, AU - Vilarrassa Rull,E, AU - Casademont I Pou,J, AU - Puig Sanz,L, Y1 - 2018/05/24/ PY - 2017/11/15/received PY - 2018/03/28/accepted PY - 2018/5/1/pubmed PY - 2019/1/27/medline PY - 2018/4/30/entrez SP - 1728 EP - 1736 JF - Journal of the European Academy of Dermatology and Venereology : JEADV JO - J Eur Acad Dermatol Venereol VL - 32 IS - 10 N2 - BACKGROUND: Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered. OBJECTIVE: To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA. METHODS: Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand. RESULTS: Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368). CONCLUSION: Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA. SN - 1468-3083 UR - https://www.unboundmedicine.com/medline/citation/29706002/Subclinical_enthesopathy_of_extensor_digitorum_tendon_is_highly_prevalent_and_associated_with_clinical_and_ultrasound_alterations_of_the_adjacent_fingernails_in_patients_with_psoriatic_disease_ L2 - https://doi.org/10.1111/jdv.15035 DB - PRIME DP - Unbound Medicine ER -