Psoriatic nail dystrophy is associated with erosive disease in the distal interphalangeal joints in psoriatic arthritis

a retrospective cohort study

A Antony, A Allard, A Rambojun, Christopher R Lovell, G Shaddick, G Robinson, D R Jadon, Richard Holland, C Cavill, E Korendowych, N J McHugh, William Tillett

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To assess if the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal joints.

METHODS: A convenience sample of patients were collated from the Bath longitudinal PsA cohort. All patients had PsA according to the CASPAR criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score (PNSS). Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the distal interphalangeal joints (DIPjs), and proximal interphalangeal or metacarpophalangeal joints (non-DIPjs) of the corresponding digits.

RESULTS: 134 patients were included, with a median age of 53 (IQR 44, 61) years and disease duration of 7 (IQR 3, 15) years. The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIPjs of the corresponding digit (OR 1.9; 95% CI 1.23, 2.83; p<0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12, 2.62; p=0.02). Nail subungal hyperkeratosis was more strongly associated with joint space narrowing, erosions and osteoproliferation at the corresponding DIPjs compared to non-DIPjs (p<0.001). Nail pitting was not associated with erosions or osteoproliferation.

CONCLUSION: The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIPjs. Subungal hyperkeratosis is more strongly associated with erosive damage at the DIPjs than non-DIPjs. These findings support the anatomical and pathological link between nail and DIP joint disease.

Original languageEnglish
JournalThe Journal of Rheumatology
Early online date1 Mar 2019
DOIs
Publication statusE-pub ahead of print - 1 Mar 2019

Cite this

Psoriatic nail dystrophy is associated with erosive disease in the distal interphalangeal joints in psoriatic arthritis : a retrospective cohort study. / Antony, A; Allard, A; Rambojun, A; Lovell, Christopher R; Shaddick, G; Robinson, G; Jadon, D R; Holland, Richard; Cavill, C; Korendowych, E; McHugh, N J; Tillett, William.

In: The Journal of Rheumatology, 01.03.2019.

Research output: Contribution to journalArticle

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title = "Psoriatic nail dystrophy is associated with erosive disease in the distal interphalangeal joints in psoriatic arthritis: a retrospective cohort study",
abstract = "OBJECTIVE: To assess if the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal joints.METHODS: A convenience sample of patients were collated from the Bath longitudinal PsA cohort. All patients had PsA according to the CASPAR criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score (PNSS). Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the distal interphalangeal joints (DIPjs), and proximal interphalangeal or metacarpophalangeal joints (non-DIPjs) of the corresponding digits.RESULTS: 134 patients were included, with a median age of 53 (IQR 44, 61) years and disease duration of 7 (IQR 3, 15) years. The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIPjs of the corresponding digit (OR 1.9; 95{\%} CI 1.23, 2.83; p<0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95{\%} CI 1.12, 2.62; p=0.02). Nail subungal hyperkeratosis was more strongly associated with joint space narrowing, erosions and osteoproliferation at the corresponding DIPjs compared to non-DIPjs (p<0.001). Nail pitting was not associated with erosions or osteoproliferation.CONCLUSION: The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIPjs. Subungal hyperkeratosis is more strongly associated with erosive damage at the DIPjs than non-DIPjs. These findings support the anatomical and pathological link between nail and DIP joint disease.",
author = "A Antony and A Allard and A Rambojun and Lovell, {Christopher R} and G Shaddick and G Robinson and Jadon, {D R} and Richard Holland and C Cavill and E Korendowych and McHugh, {N J} and William Tillett",
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TY - JOUR

T1 - Psoriatic nail dystrophy is associated with erosive disease in the distal interphalangeal joints in psoriatic arthritis

T2 - a retrospective cohort study

AU - Antony, A

AU - Allard, A

AU - Rambojun, A

AU - Lovell, Christopher R

AU - Shaddick, G

AU - Robinson, G

AU - Jadon, D R

AU - Holland, Richard

AU - Cavill, C

AU - Korendowych, E

AU - McHugh, N J

AU - Tillett, William

PY - 2019/3/1

Y1 - 2019/3/1

N2 - OBJECTIVE: To assess if the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal joints.METHODS: A convenience sample of patients were collated from the Bath longitudinal PsA cohort. All patients had PsA according to the CASPAR criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score (PNSS). Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the distal interphalangeal joints (DIPjs), and proximal interphalangeal or metacarpophalangeal joints (non-DIPjs) of the corresponding digits.RESULTS: 134 patients were included, with a median age of 53 (IQR 44, 61) years and disease duration of 7 (IQR 3, 15) years. The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIPjs of the corresponding digit (OR 1.9; 95% CI 1.23, 2.83; p<0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12, 2.62; p=0.02). Nail subungal hyperkeratosis was more strongly associated with joint space narrowing, erosions and osteoproliferation at the corresponding DIPjs compared to non-DIPjs (p<0.001). Nail pitting was not associated with erosions or osteoproliferation.CONCLUSION: The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIPjs. Subungal hyperkeratosis is more strongly associated with erosive damage at the DIPjs than non-DIPjs. These findings support the anatomical and pathological link between nail and DIP joint disease.

AB - OBJECTIVE: To assess if the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal joints.METHODS: A convenience sample of patients were collated from the Bath longitudinal PsA cohort. All patients had PsA according to the CASPAR criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score (PNSS). Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the distal interphalangeal joints (DIPjs), and proximal interphalangeal or metacarpophalangeal joints (non-DIPjs) of the corresponding digits.RESULTS: 134 patients were included, with a median age of 53 (IQR 44, 61) years and disease duration of 7 (IQR 3, 15) years. The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIPjs of the corresponding digit (OR 1.9; 95% CI 1.23, 2.83; p<0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12, 2.62; p=0.02). Nail subungal hyperkeratosis was more strongly associated with joint space narrowing, erosions and osteoproliferation at the corresponding DIPjs compared to non-DIPjs (p<0.001). Nail pitting was not associated with erosions or osteoproliferation.CONCLUSION: The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIPjs. Subungal hyperkeratosis is more strongly associated with erosive damage at the DIPjs than non-DIPjs. These findings support the anatomical and pathological link between nail and DIP joint disease.

U2 - 10.3899/jrheum.180796

DO - 10.3899/jrheum.180796

M3 - Article

JO - The Journal of Rheumatology

JF - The Journal of Rheumatology

SN - 0315-162X

ER -