gms | German Medical Science

Background: Psoriasis of the nails is an extreme diagnostic and therapeutic challenge, and often a great burden for the patients. Nail involvement is effecting more than 50% of patients with psoriasis (PsO). It is the strongest predictor of developing psoriatic arthritis (PsA). In more than 80% of the patients suffering from nail psoriasis psoriatic arthritis is found. There is a well known anatomical relation between DIP joint, extensor tendon enthesitis and nail matrix, therefore a unifying pathogenetical mechanism is postulated emerging from enthesitis.

We made the experience in daily practic (under real life conditions) that in our patients with nail psoriasis and PsO or PsA in ultrasound Power Doppler (PD) not only hypervascularisation (HV) of the extensor tendon of the dip joint is seen. Why do we often see a hypervascularisation of the nail matrix without any relation to the dip joint and tendon (despite the small anatomical distance). In these cases we often see more twist signs in capillaroscopy.

We present the first data of our pilot study of 10 patients

Methods: Ultrasound Powerdoppler examination and capillaroscopy in patients with nail psoriasis with Pso and PsA was performed.

Results: 6 of 10 patients showed hypervascularisation (PD HV) of the extensor tendon region. 8 of 10 patients showed strong PD HV signals of the nail matrix. Twist/Torsion signsin capillaroscopy were seen in 7of these 8 patients.

Conclusion: To proof our data a prospective study is started comparing PD ultrasound and capillaroscopy findings in PsO and PsA patients with and without nail psoriasis. PD ultrasound and capillaroscopy is easy to perform in daily rheumatologic practice. Twisted capillaries and hypervascularisation of the nail matrix are clinical signs of active nail psoriasis and seem to be a strong indicator for an early effective therapy in PsO and PsA.