Nail Psoriasis in Individuals With Psoriasis Vulgaris: A Study of 661 Patients

Armesto, S.; Esteve, A.; Coto-Segura, P.; Drake, M.; Galache, C.; Martínez-Borra, J.; Santos-Juanesc, J.

doi:10.1016/S1578-2190(11)70819-8

Información del artículo

Abstract

Background and objectives

The nails are affected in a substantial number of patients with psoriasis. Nevertheless, few epidemiological studies have reported the characteristics of patients with nail psoriasis. Here we describe the epidemiology of nail psoriasis and the main characteristics of affected patients.

Patients and methods

We undertook a prospective case-control study at Hospital Universitario Marqués de Valdecilla and Hospital Universitario Central de Asturias in Spain between January 2007 and December 2009.

Results

Of a total of 661 patients included, 47.4% were diagnosed with nail psoriasis, which was 13.5% more prevalent in men. The group of patients with nail disease had more severe psoriasis (12.82 vs 8.22 points on the psoriasis area and severity index) and a longer disease duration (20.30 vs 13.94 years), and included a larger percentage of patients with psoriatic arthritis (29.7% vs 11.5%), a positive family history of the disease (53.7% vs 42.8%), and a body mass index greater than 30 (31.6% vs 23.9%). A larger percentage of the patients with nail disease had early-onset psoriasis (74.1% vs 65.5%) and fewer were carriers of the human lymphocyte antigen Cw*0602 allele (33% vs 50.3%).

Conclusions

Nail disease is frequent in psoriasis and is associated with greater severity of psoriasis and a larger number of comorbidities.

Keywords:

Psoriasis

Nail

Resumen

Introducción y objetivos

La psoriasis ungueal afecta a un número importante de pacientes con psoriasis. No obstante, son raros los estudios epidemiológicos que recojan las características de estos individuos. Describimos la epidemiología y principales características de los pacientes con psoriasis ungueal.

Material y método

Se trata de un estudio prospectivo de casos y controles realizado en el Hospital Universitario Marqués de Valdecilla y Hospital Universitario Central de Asturias entre enero de 2007 y diciembre de 2009.

Resultados

De un total de 661 pacientes la psoriasis ungueal fue diagnosticada en el 47,4% de los pacientes. La prevalencia fue 13,5 puntos mayor en hombres que en mujeres. Los pacientes con afectación ungueal presentan mayor severidad de la enfermedad (PASI 12,82 vs 8,22), mayor duración de la misma (20,30 vs 13,94 años), incidencia superior de artropatía psoriática (29,7% vs 11,5%), mayor frecuencia de antecedentes familiares positivos (53,7% vs 42,8%) y mayor proporción de obesidad IMC > 30 (31,6 vs 23,9%). La psoriasis en el grupo con afectación ungueal se inicia de forma precoz (74,1 vs 65,5%) y se asocia con menor frecuencia a Cw*0602 (33 vs 50,3%).

Conclusiones

La afectación ungueal es una manifestación frecuente en los pacientes con psoriasis y se asocia a mayor gravedad de la enfermedad y mayor número de comorbilidades.

Palabras clave:

Psoriasis

Uña

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References

[1.]

J. Gudjonsson, A. Karason, E.H. Hjaltey Runarsdottir, A. Antonsdottir, V.B. Hauksson, H. Jonsson, et al.

Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patientsan analysis of 1019 HLA-C and HLA-B-typed patients.

J Invest Dermatol, 126 (2006), pp. 740-745

http://dx.doi.org/10.1038/sj.jid.5700118 | Medline

[2.]

K. Reich.

Approach to managing patients with nail psoriasis.

J Eur Acad Dermatol Venereol, 23 (2009), pp. 15-21

http://dx.doi.org/10.1111/j.1468-3083.2009.03364.x | Medline

[3.]

M. Sanchez Regaña, R. Ojeda, I. Umbert, P. Umbert, W. Lupo, J. Solé.

El impacto psicosocial de la psoriasis.

Actas Dermosifiliogr, 94 (2003), pp. 11-16

[4.]

E.M. De Jong, M.A. Seegers, M.K. Gulinch, J.B. Boezeman, P.C. van de Kerkhof.

Psoriasis of the nail associated with disability in a large number of patients: results of a recent interview with 1,728 patients.

Dermatology, 193 (1996), pp. 300-303

Medline

[5.]

M. Sánchez-Regaña, J. Sola-Ortigosa, M. ALsina-Gibert, M. Vidal- Fernández, P. Umbert-Millet.

Nail Psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy).

J Eur Acad Dermatol Venereol, 25 (2011), pp. 579-586

http://dx.doi.org/10.1111/j.1468-3083.2010.03938.x | Medline

[6.]

M.M. Jiaravuthisan, D. Dasseville, R.B. Vender, F. Murphy, C.Y. Muhn.

Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy.

J Am Acad Dermatol, 57 (2007), pp. 1-27

http://dx.doi.org/10.1016/j.jaad.2005.07.073 | Medline

[7.]

M. Sánchez Regaña, M. Iglesias, L. Creus, P. Umbert.

Prevalencia de enfermedades hepáticas crónicas en pacientes con psoriasis.

Actas Dermosifiliogr, 91 (2000), pp. 498-510

[8.]

S. Van Laborde, R.K. Scher.

Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. A review of the literature.

Dermatol Clin, 18 (2000), pp. 37-46

Medline

[9.]

L. Mallbris, P. Larsson, S. Bergqvist, E. Vignard, F. Granath, M. Stahle.

Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases.

J Invest Dermatol, 124 (2005), pp. 454-499

[10.]

Obesity: preventing and managing the global epidemic.

Report a WHO consultation.

World Health Organ Tech Rep Ser, 894 (2000), pp. 1-253

[11.]

J. Schmitt, G. Wozel.

The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis.

Dermatology, 210 (2005), pp. 194-199

http://dx.doi.org/10.1159/000083509 | Medline

[12.]

G. Gudnadottir, I. Hilmarsdottir, B. Sigurgeirsson.

Onychomycosis in Icelandic swimmers.

Acta Derm Venereol, 79 (1999), pp. 376-377

Medline

[13.]

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).

JAMA, 16 (2001), pp. 2486

[14.]

M. Augustin, K. Reich, C. Blome, I. Schäfer, A. Laass, M.A. Radtke.

Nail psoriasis in Germany: epidemiology and burden of disease.

Br J Dermatol, 163 (2010), pp. 580-585

http://dx.doi.org/10.1111/j.1365-2133.2010.09831.x | Medline

[15.]

Taieb C, Myon E, Voisard JJ, Marin N, Corvest M. Nail psoriasis: epidemiological study in France. Poster presented at the EADV 14th Congress. London, October 2005.

[16.]

R. Baran.

The burden of nail psoriasis: an introduction.

Dermatology, 221 (2010), pp. 1-5

http://dx.doi.org/10.1159/000316169 | Medline

[17.]

D. McGonagle, N. Palmou Fontana, A.L. Tan, M. Benjamín.

Nailing down the genetic and immunological basis for psoriatic disease.

Dermatology, 221 (2010), pp. 15-22

http://dx.doi.org/10.1159/000316171 | Medline

[18.]

X. Fan, S. Yang, L. Dan Sun, Y. Hua Liang, M. Gao, K. Zhang, et al.

Comparison of clinical features of HLA-Cw*0602-positive and negative psoriasis patiens in a Han Chinese Population.

Acta Derm Venereol, 87 (2007), pp. 335-340

http://dx.doi.org/10.2340/00015555-0253 | Medline

[19.]

S. González, J. Martínez-Borra, J. Del Río, J. Santos-Juanes, A. López-Vázquez, M. Blanco-Gelaz, et al.

The OTF-3 gene polymorphism confers susceptibility to psoriasis independent of the association of HLA-Cw*0602.

J Invest Dermatol, 115 (2000), pp. 824-828

http://dx.doi.org/10.1046/j.1523-1747.2000.00133.x | Medline

[20.]

J. Martínez-Borra, S. González, J. Santos-Juanes, J. Sánchez del Río, J.C. Torre Alonso, A. López-Vazquez, et al.

Psoriasis vulgaris and psoriatic arthritis share a 100kb susceptibility region telomeric to HLA-C.

Rheumatology, 42 (2003), pp. 1089-1092

http://dx.doi.org/10.1093/rheumatology/keg304 | Medline

[21.]

F.C. Wilson, M. Icen, C.S. Crowson, M.T. Mc Evoy, S.E. Gabriel, H.M. Kremers.

Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study.

Arthritis Rheum, 61 (2009), pp. 233-239

http://dx.doi.org/10.1002/art.24172 | Medline

[22.]

M. Lawry.

Biological therapy and nail psoriasis.

Dermatol Ther, 20 (2007), pp. 60-67

http://dx.doi.org/10.1111/j.1529-8019.2007.00112.x | Medline

[23.]

R.P.R. Dawber.

Science of the nail apparatus.

Diseases of the Nails and Their Management, Blackwell Science, (2001),

[24.]

D. McGonagle, A.L. Tan, M. Benjamin.

The nail as a musculoskeletal appendage - implications for an improved understanding of the link between psoriasis and arthritis.

Dermatology, 218 (2009), pp. 97-102

http://dx.doi.org/10.1159/000182250 | Medline

[25.]

A.L. Tan, M. Benjamin, H. Toumi, A.J. Grainger, S.F. Tanner, P. Emery, et al.

The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis - a high-resolution MRI and histological study.

Rheumatology, 46 (2007), pp. 253-256

http://dx.doi.org/10.1093/rheumatology/kel214 | Medline

[26.]

M.R. Cohen, D.J. Reda, D.O. Clegg.

Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans affairs cooperative study group on seronegative spondyloarthropathies.

J Rheumatol, 26 (1999), pp. 1752-1756

Medline

[27.]

D. McGonagle.

Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease.

J Eur Acad Dermatol Venereol, 23 (2009), pp. 9-13

http://dx.doi.org/10.1111/j.1468-3083.2009.03363.x | Medline

[28.]

S.M. Jones, J.B. Armas, M.G. Cohen, C.R. Lovel, G. Evison, N.J. McHugh.

Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease.

Br J Rheumatol, 33 (1994), pp. 834-839

Medline

[29.]

D.D. G ladman, R. Shuckett, M.L. Russell, J.C. Thorne, R.K. Schachter.

Psoriatic arthritis (PSA): an analysis of 220 patients.

Q J Med, 62 (1987), pp. 127-141

Medline

[30.]

V. Wright, M.C. Roberts, A.G. Hill.

Dermatological manifestations in psoriatic arthritis: a follow-up study.

Acta Derm Venereol, 59 (1979), pp. 235-240

Medline

[31.]

G. Serarslan, H. Guler, S. Karazincir.

The relationship between nail- and distal phalangeal bone involvement severity in patients with psoriasis.

Clin Rheumatol, 26 (2007), pp. 1245-1247

http://dx.doi.org/10.1007/s10067-006-0476-y | Medline

[32.]

L. Williamson, N. Dalbeth, J.L. Dockerty, B.C. Gee, R. Weatherall, B.P. Wordsworth.

Extended report: nail disease in psoriatic arthritis: clinically important, potentially treatable and often overlooked.

Rheumatology (Oxford), 43 (2004), pp. 790-794

[33.]

R. Scarpa, E. Soscia, R. Peluso, M. Atteno, F. Manguso, A. Del Puente, et al.

Nail and distal interphalangeal joint in psoriatic arthritis.

J Rheumatol, 33 (2006), pp. 1315-1319

Medline

[34.]

T.E. Christensen, K.P. Callis, J. Papenfuss, M.S. Hoffman, C.B. Hansen, B. Wong, et al.

Observations of psoriasis in the absence of therapeutic intervention identifies two unappreciated morphologic variants, thin-plaque and thick-plaque psoriasis, and their associated phenotypes.

J Invest Dermatol, 126 (2006), pp. 2397-2403

http://dx.doi.org/10.1038/sj.jid.5700489 | Medline

[35.]

C. Zhang, K.J. Zhu, H.F. Zheng, Y. Cui, F.S. Zhou, Y.L. Chen, et al.

The effect of overweight and obesity on psoriasis patients in Chinese Han population: a hospital-based study.

J Eur Acad Dermatol Venereol, 25 (2011), pp. 87-91

http://dx.doi.org/10.1111/j.1468-3083.2010.03706.x | Medline

[36.]

T.J. Love, J.E. Gudjonsson, H. Valdimarsson, B. Gudbjornsson.

Small joint involvement in psoriatic arthritis is associated with onycholysis: the Reykjavik psoriatic arthritis study.

Scan J Rheumatol, 39 (2010), pp. 299-302

[37.]