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Review
. 2017;55(3):131-135.
doi: 10.5114/reum.2017.68912. Epub 2017 Jul 18.

Nail involvement in psoriatic arthritis

Piotr Sobolewski  1 , Irena Walecka  1 , Klaudia Dopytalska  1
Affiliations
Review

Nail involvement in psoriatic arthritis

Piotr Sobolewski et al. Reumatologia. 2017.

Abstract

Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.

Keywords: nail psoriasis; psoriatic arthritis; treatment of nail changes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Nail psoriasis. Pitting.
Fig. 2
Fig. 2
Onychomadesis in nail psoriasis.
Fig. 3
Fig. 3
Onycholysis in nail psoriasis.
Fig. 4
Fig. 4
Nail psoriasis. Subungual hyperkeratosis.
Fig. 5
Fig. 5
Oil drop sign in nail psoriasis.
Fig. 6
Fig. 6
Nail psoriasis. Splinter hemorrhages.
Fig. 7
Fig. 7
Advanced nail changes in severe psoriasis – nail pitting, onycholysis, subungual hyperkeratosis and splinter haemorrhages.
See this image and copyright information in PMC

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