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Psoriasis Nail Involvement a Risk Factor for Psoriatic Arthritis, Increased Psoriasis Severity
These results highlight the association between nail psoriasis and various factors such as male sex and smoking.
Psoriasis nail involvement is significantly higher among patients who are smokers, male, and who report longer duration of disease, recent findings suggest, and these results suggest psoriatic nail affection is a risk factor for psoriatic arthritis (PsA) and more severe levels of disease.1
The investigative team that highlighted these findings in a recent analysis was led by Nermeen Ibrahim Bedair, MD, from the Department of Dermatology, Andrology, Sexual Medicine, and STD at Helwan University in Egypt. Bedair and the team highlighted that
“In the current retrospective study, we aimed to compare the epidemiologic and clinical aspects of psoriasis patients with and without nail involvement in an attempt to shed more light on nail psoriasis characteristics and associations,” Bedair and colleagues wrote.1
All individuals diagnosed with psoriasis who sought care at the Kasr Al Ainy Psoriasis Unit (KAPU), affiliated with the Dermatology Departments of Cairo University and Helwan University, were evaluated by the investigative team in a retrospective chart review between December 2015 - August 2020. Personal identifiers were removed by the teams at both institutions for the purposes of confidentiality.
Male and female patients with psoriasis were considered eligible for inclusion in the study if their medical records contained complete or near-complete data. Complete data was defined as no more than 3 variables missing from the records. Documentation required by Bedair et al. included clinical history and demographics.
Examples of such data included as gender, rural versus urban residency, age, onset of psoriasis, disease progression, triggers and relieving factors, duration of disease, previous therapies, any coexisting systemic or dermatological conditions or major surgery histories, and family psoriasis history.
Overall, 2888 individuals were shown to have met the inclusion criteria and were incorporated into Bedair and colleagues' final analysis. Comprehensive records needed to include data drawn from physical examinations and baseline lab results—liver function tests, fasting and 2-hour postprandial blood glucose, hepatitis virus markers, and participants' lipid profiles.
In the process of documentation, the investigators also had to detail the severity, subtype, and distribution of psoriasis among the trial subjects. They also assessed psoriatic arthritis status through the use of the validated Psoriasis Epidemiology Screening Tool (PEST).
In their evaluation of participants, the team also looked at Psoriasis Area and Severity Index (PASI) scores, body mass index (BMI), and Psoriasis Disability Index (PDI). They would categorize participants into 2 cohorts based on nail involvement. Specifically, the categories were participants with nail psoriasis (PsN) and those who were without (Ps). Among the 2888 total patients, 18% were found to have nail changes, whereas 2363 had no clinical nail involvement.
They used multivariate logistic regression, aiming to identify independent predictors of nail psoriasis and to assess any factors that could have an influence on such associations. Bedair's team concluded that nail involvement was significantly more prevalent among cigarette smokers, male patients, subjects with longer disease duration, patients diagnosed with PsA, and those who were being treated with metformin therapy.
Notably, there was a lack of significant correlation identified between nail involvement and either diabetes status or physically demanding occupations. The team did acknowledge some of the limitations typical of retrospective trials, such as incomplete data capture and limited ability to control for confounders.
“Early detection and systemic intervention for patients suffering from nail psoriasis is an interesting area for future research, especially if such an approach could prevent unfavourable disease consequences,” they concluded.1
References
Bedair NI, EL-Komy MHM, Elhamy N, et al. Nail Involvement Among Psoriasis Patients: A Comparative Retrospective Cohort Analysis of 2888 Egyptian Patients. Exp Dermatol, 34: e70105. https://doi.org/10.1111/exd.70105.
KRR Schons, CF Knob, N Murussi, et al. “Nail Psoriasis: A Review of the Literature,” Anais Brasileiros de Dermatologia 89, no. 2 (2014): 312–317, https://doi.org/10.1590/abd1806-4841.20142633.
