title: Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails.
abstract: OBJECTIVE
  Enthesopathy is a major feature of psoriatic arthritis (PsA), which is supported by imaging studies. Given that nail disease often predates PsA and that the nail is directly anchored to entheses, the authors asked whether nail involvement in psoriasis equates with a systemic enthesopathy.
  
  
  METHODS
  Forty-six patients with psoriasis (31 with nail disease) and 21 matched healthy controls (HC) were recruited. 804 entheses of upper and lower limbs were scanned by an ultrasonographer blinded to clinical details.
  
  
  RESULTS
  Psoriasis patients had higher enthesitis scores than HC (median (range) 21 (0-65) vs 11 (3-39), p=0.005). Enthesopathy scores were higher in patients with nail disease (23 (0-65)) than in patients without nail disease (15 (5-26), p=0.02) and HC (11 (3-39), p=0.003). Inflammation scores of patients with nail disease (13 (0-34)) were higher than patients without nail disease (8 (2-15), p=0.02) and HC (5 (0-19), p<0.001). Modified nail psoriasis severity index scores were correlated to both inflammation (r(2)=0.45, p=0.005) and chronicity scores (r(2)=0.35, p=0.04). No link between the psoriasis area and severity index and enthesitis was evident.
  
  
  CONCLUSIONS
  The link between nail disease and contemporaneous subclinical enthesopathy offers a novel anatomical basis for the predictive value of nail psoriasis for PsA evolution.
authors.affiliation: Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK.
authors.forename: Zoe R
authors.initials: ZR
authors.lastname: Ash
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tinazzi
authors.forename: Concepción C
authors.initials: CC
authors.lastname: Gallego
authors.forename: Chung
authors.initials: C
authors.lastname: Kwok
authors.forename: Caroline
authors.initials: C
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Goodfield
authors.forename: Paolo
authors.initials: P
authors.lastname: Gisondi
authors.forename: Ai Lyn
authors.initials: AL
authors.lastname: Tan
authors.forename: Helena
authors.initials: H
authors.lastname: Marzo-Ortega
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Dennis G
authors.initials: DG
authors.lastname: McGonagle
authors.forename: Sibel Z
authors.initials: SZ
authors.lastname: Aydin
mesh_terms: D000293:Adolescent; D000328:Adult; D015535:Arthritis, Psoriatic / Q000150:complications / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000209:etiology*; D015588:Observer Variation; D054850:Osteophyte / Q000000981:diagnostic imaging / Q000209:etiology; D011565:Psoriasis / Q000150:complications* / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D055815:Young Adult