title: Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis.
abstract: Differentiation between psoriatic arthritis (PsA) sine psoriasis and rheumatoid arthritis (RA) may be a challenge, especially in the early stages, hence the need for new instrumental markers to assist their diagnosis. In this study, we investigated possible dermoscopic differences in vascular appearance of nail fold and elbow (a classic site of repeated trauma) in these two conditions. Fifteen patients with PsA sine psoriasis, 12 patients with RA and 12 controls were included in the study. Regarding the nail fold vascular appearance in PsA sine psoriasis and RA cohorts, the presence of diffuse reddish background with or without sparse dotted vessels was significant in the former, whereas the evidence of parallel dotted/short linear vessels ("fish school-like" pattern) or irregular/ramified, blurry, purple vessels were significant in the latter; none of these patterns were detected in the control group. Regarding the elbow, the pattern significantly associated with PsA sine psoriasis consisted of diffusely distributed, red, dotted vessels. On the other hand, RA patients and controls displayed similar dermoscopic findings, with three possible vascular patterns being observed: (i) irregular, blurry, purple vessels; (ii) avascular appearance; and (iii) sparse, dotted, purple vessels. In conclusion, dermoscopy may be a useful supportive tool for differentiating early PsA sine psoriasis from RA.
authors.affiliation: Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Errichetti
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: Alen
authors.initials: A
authors.lastname: Zabotti
authors.affiliation: Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stinco
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Quartuccio
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Sacco
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: Ginevra
authors.initials: G
authors.lastname: De Marchi
authors.affiliation: Department of Dermatology, San Carlo Hospital, Potenza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Piccirillo
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy. devita.salvatore@aoud.sanita.fvg.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D046169:Dermoscopy / Q000295:instrumentation / Q000379:methods*; D003937:Diagnosis, Differential; D004550:Elbow / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply / Q000000981:diagnostic imaging*
keywords: dermoscopy; onychoscopy; psoriatic arthritis; psoriatic arthritis sine psoriasis; rheumatoid arthritis