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Psoriasis is a chronic recurrent inflammatory skin disease with prevalence of 1–3%. Nail psoriasis affects 10–90% of patients with plaque psoriasis.
The aim of the article is to review the literature for the correlation between nail psoriasis and psoriatic arthritis (PsA) to provide rheumatologists a short review on features of nail psoriasis, meth...
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Objectives:
To identify patient- and disease-related characteristics that make it possible to predict higher disease severity in recent-onset PsA.
Methods:
We performed a multicenter observational prospective study (2-year follow-up, regular annual visits). The study population comprised patients aged ≥ 18 years who fulfilled the CASPAR criteria...
Citations
... Nesse sentido, a pontuação do NAPSI é a soma total dos escores obtidos. Por fim, NAPSI alvo é caracterizado quando apenas a unha mais afetada for avaliada, cujo objetivo é a análise dos efeitos de um regime terapêutico instituído (NIERADKO-IWANICKA, 2017;HANEKE, 2017). sintomas psoriáticos cutâneos e/ou articulares (NIERADKO-IWANICKA, 2017;HANEKE, 2017;KAELEY et al., 2021). ...
... Por fim, NAPSI alvo é caracterizado quando apenas a unha mais afetada for avaliada, cujo objetivo é a análise dos efeitos de um regime terapêutico instituído (NIERADKO-IWANICKA, 2017;HANEKE, 2017). sintomas psoriáticos cutâneos e/ou articulares (NIERADKO-IWANICKA, 2017;HANEKE, 2017;KAELEY et al., 2021). ...
... deixando a ponta do dedo vermelha e lisa, até que a doença desapareça lentamente(HANEKE, 2017; SHAN et al., 2021).Por fim, a paroníquia está relacionada a lesões psoriáticas que afetam a superfície dorsal e ventral da prega ungueal proximal, gerando eritema e escamas nos dígitos. Esse processo leva à perda espontânea da cutícula, sendo responsável pelo padrão de paroníquia crônica(HANEKE, 2017;NIERADKO-IWANICKA, 2017).6 CLASSIFICAÇÃOO Índice de Gravidade da Psoríase Ungueal (NAPSI) é uma escala de graduação numérica, objetiva, quantitativa, simples e rápida. ...
A psoríase é caracterizada por uma doença inflamatória crônica, recorrente e imunomediada. Estima-se que 3% da população e cerca de 90% dos pacientes acometidos pela afecção manifestam alterações ungueais. Sua etiologia ainda é incerta, entretanto, fatores ambientais, psicológicos, genéticos e imunológicos são algumas condições relacionadas à patogênese da doença. O paciente com psoríase ungueal (PU) pode ter uma ou múltiplas unhas acometidas e as manifestações clínicas podem ser diversas em cada unha psoriática. Nesse cenário, o diagnóstico da PU é pautado primordialmente nas manifestações clínicas. Entretanto, em casos reservados, faz-se necessário lançar mão de exames complementares para confirmação da PU. Quanto à sua classificação, utiliza-se o Índice de Gravidade da Psoríase Ungueal (NAPSI), que é uma escala de graduação numérica, objetiva, quantitativa e simples para caracterizar as lesões em níveis de 0 a 4. No que tange ao tratamento, a PU é uma das formas de psoríase que apresenta o manejo mais difícil, por esse motivo há várias pesquisas sobre métodos terapêuticos e, simultaneamente, há muita divergência sobre qual recurso utilizar. Por fim, os pacientes com unhas psoriáticas possuem sua qualidade de vida fortemente influenciada por elas e podem apresentar prejuízos funcionais em casos mais graves. Frente a esse quadro, é de suma importância o acompanhamento contínuo e focado no ser biopsicossocial, visando mitigar eventuais malefícios inerentes à afecção.
... NP can occur in all portions of the nail unit, and the clinical features of NP, such as pitting, onycholysis, and crumbling, depend on which part of the nail unit is affected by the psoriatic inflammatory process ( Figure 2). 10,12,13,22,23 The symptoms of nail matrix PsO depend on the precise location of PsD in the proximal or distal matrix, as well as the transverse extent and duration of the disease process. Pitting, crumbling, and leukonychia are caused by foci of PsO pathology in the nail matrix that forms the nail plate. ...
Objective
An estimated 40%–50% of patients with psoriasis have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (eg, enthesitis, arthritis) and we review targeted therapies for nail psoriasis.
Methods
We performed a literature search to identify which systemic therapies approved for the treatment of psoriasis and/or psoriatic arthritis (PsA) have been evaluated for the treatment of nail psoriasis, either as a primary or secondary outcome. A total of 1546 articles were identified on February 18, 2019 and evaluated for relevance.
Results
We included findings from 66 articles on systemic therapies for the treatment of nail psoriasis in psoriatic disease. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Severity Index, there was a high level of methodological heterogeneity across studies.
Conclusion
Nail psoriasis is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat nail psoriasis to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized nail psoriasis scoring systems and well-defined treatment guidelines to improve management of psoriatic disease.
... 11 Nail involvement includes nail pitting (Figure 4), trachyonychia, onychauxis, onychorrhexis ("brittle nails"), leukonychia ( Figure 5), onycholysis (Figure 6), Beau lines, onychomadesis, oil drop discoloration, red spots (salmon patches) in the lunula (mottled lunula), dyschromias, longitudinal ridges, subungual hyperkeratosis (Figure 7), splinter hemorrhage (Figure 8), nail plate crumbling (Figure 9), or a combination thereof. 1,2,[5][6][7][12][13][14][15][16][17] Nail plate crumbling may progress to total nail matrix destruction after a prolonged period of disease activity. 15 By far, pitting is the most common manifestation of nail psoriasis and occurs in approximately 70% of patients with nail psoriasis. ...
... NP is strongly associated with psoriatic arthritis (3), with a direct correlation between the duration of psoriasis and the severity of nail involvement (4). Nail involvement in psoriatic patients causes restrictions in patients' daily activities with a significant impact on their quality of life (5). ...
Background:
Nail psoriasis (NP) is frequently seen in psoriatic patients. It is difficult to treat and shows unsatisfactory response to topical preparations. Recently, different types of Lasers have been shown to be effective in some nail disorders.
Aim:
The aim was to evaluate the efficacy and safety of long-pulsed Nd: YAG laser 1,064 nm as a method for NP treatment.
Methods:
A prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 22 patients with bilateral fingernail psoriasis, randomly assigned into right or left-side therapy with either four sessions of long-pulsed Nd:YAG laser once monthly or daily topical placebo for 4 months, followed by 3 months follow-up. Evaluation was done using NP severity index at baseline, second month, fourth month and after follow-up period. Clinical and dermoscopic photographs were taken both at baseline and at 4th month.
Results:
There was a statistically significant improvement in both NP severity index and dermoscopic features in laser side, along with significant difference between laser and placebo side. Nail bed showed obvious improvement than nail matrix.
Conclusion:
Nd:YAG laser represents an effective and safe modality for NP treatment and dermoscopy is a useful tool for treatment efficacy assessment.
... Nails are skin appendages. If psoriasis involves the nail matrix, nail psoriasis shows up as changes in the nail plate such as pitting, Beau lines, leukonychia, red spots in the lunula, and nail plate crumbling [15]. Nail psoriasis is accompanied by onychomycosis in up to 27% of cases [14]. ...
DIRA (deficiency of the IL-1Ra) is a rare condition that usually presents in the neonatal period. Patients with DIRA present with systemic inflammation, respiratory distress, joint swelling, pustular rash, multifocal osteomyelitis, and periostitis. Previously, we reported a patient with a novel mutation in IL1RN with a healthy neonatal period, a late-onset of pustular dermatosis, inflammatory arthritis, and excellent response to canakinumab treatment. Herein, we are presenting a new case of late-onset DIRA syndrome, carrying a different mutation and showing different clinical findings. This patient is the first one in the literature with the inflammatory arthritis, nail psoriasis, and onychomycosis and with her remarkable response to monoclonal antibodies. The case responded well and fully recovered after treatment with adalimumab, but not with canakinumab. The DIRA disease can lead to death from multiple organ failures and if recognized early, the treatment with replacement of the deficient protein with biologic agents induces rapid and complete remission. Therefore, clinical symptoms should be learned exactly by the pediatricians, pediatric rheumatologists, and immunologists; and molecular analysis targeting this defect must be performed as early as possible.
... Nail disease is a prevalent feature in both psoriasis and PsA and it can negatively impact quality of life [45]. Most studies use the Nail Psoriasis Severity Index (NAPSI) or variations of this measure. ...
Purpose of review
To provide clinicians evidence-based strategies to diagnose and treat psoriatic arthritis (PsA) patients based on involvement of the key domains peripheral arthritis, psoriasis and nails, axial involvement, dactylitis, and enthesitis, with the goal of improving outcomes for PsA patients by lessening joint pain and swelling and the degree of inflammation in the other key domains. It is also imperative to limit or eliminate progressive X-ray damage.
Recent findings
Evidence from phase III randomized trials demonstrate that agents that inhibit tumor necrosis factor (TNF), interleukin (IL)-17, and IL12/23 relieve joint inflammation and decrease or completely inhibit radiographic progression. Agents that block TNF and IL-17 are also effective for axial disease. Additional agents effective for psoriatic arthritis but without documentation of effect on progressive damage include apremilast, abatacept, and tofacitinib. Most agents have demonstrated efficacy for treatment of enthesitis and dactylitis.
Summary
A number of therapies that effectively treat the key domains of psoriatic arthritis are now available. Comprehensive assessment of patients to determine the extent and degree of domain involvement is essential to properly individualize treatment, improve outcomes, and limit progressive joint damage.
Objective:
To provide an overview of commonly used outcome measure in psoriatic arthritis (PsA).
Background:
PsA is a heterogenous inflammatory arthritis, associated with psoriasis that affects between 0.1% and 2% of the population and approximately one in three patients with psoriasis. Psoriatic arthritis places a significant burden on patients' overall quality of life and is associated with a range of comorbidities. Although assessment of patients and monitoring of symptoms has greatly improved over the last 2 decades, capturing disease activity in this multisystem disease remains challenging. Previous efforts have traditionally focussed on assessment of individual disease domains, however recent evidence suggests that composite measurements, particularly those incorporating patient reported outcomes may not only help monitor disease activity more accurately, but also help in accurately validating therapy outcomes in PsA patients.
Purpose:
This review discusses currently used outcome measurements in PsA and also highlights the importance of emerging measurements such as biomarkers and their possible role in capturing treatment response.
Nail psoriasis affects a large number of patients with psoriasis and has a major psychosocial impact. Furthermore, it may be regarded as a predictor of more severe forms of psoriasis and early sign of psoriatic arthritis. The clinical presentations vary depending on the structure affected (nail matrix or nail bed), the nail lesions may range from minor to severe, but they are not specific. Treatment is a challenge, in most cases the lesions being resistant to therapy. We present a rare case of psoriasis with nail onset in a 59-year-old woman. The nail involvement confined to the fingernails was severe, with significant impairment of the patient’s quality of life. Conventional therapies failed to improve the nail lesions, but a marked improvement was achieved under etanercept therapy
