HRUS in the evaluation of the nails in patients with Psoriasis.

Transcription

1 HRUS in the evaluation of the nails in patients with Psoriasis. Poster No.: C-0512 Congress: ECR 2017 Type: Scientific Exhibit Authors: I. Mussetto, N. Romano, A. Fischetti, M. Burlando, A. Muda; Genova/IT Keywords: Inflammation, Diagnostic procedure, Ultrasound-Power Doppler, Ultrasound, Soft tissues / Skin, Musculoskeletal system, Extremities DOI: /ecr2017/C-0512 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 17

2 Aims and objectives Psoriasis is one of the most common immune-mediated inflammatory and chronic skin diseases that affects approximately 1-3% of the population. Nails can be affected in % of patients with psoriasis. The aim of this study was to show the potential of the latest sonographic equipment using high-frequency probes in depicting nail changes in patient with psoriatic onychopathy. Page 2 of 17

3 Methods and materials From March 2016 to July 2016, 17 patient with diagnosis of psoriasis and 10 healthy control participants were enrolled in the study. 17 patients (range y.o) (10F, 7M), from the Dermatology Section of the University Hospital "San Martino" of Genoa, and 10 healthy control participants (5F,5M) (range 2666 years y.o). For both groups, for each nail, we calculated a clinic score: NAPSI (Nail Psoriasis Severity Index). NAPSI is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis. It is used to assign a score to each nail for nail bed psoriasis and nail matrix psoriasis by area of involvement in the nail unit. Nail plate is divided into quadrants by imaginary longitudinal and horizontal lines. Score is 0 if the findings are not present, 1 if they are present in 1 quadrant of the nail, 2 if present in 2 quadrants, 3 if present in 3 quadrants and 4 if present in 4 quadrants of the nail. Each nail has a matrix score (0-4) and a nail bed score (0-4), so the total nail score ranges from 0 to 8. All patients and healthy control participants underwent a sonographic examination with a high frequency transducer of 22MHz (MyLab-Twice, Esaote Biomedica, Genoa, Italy). Each nail was scanned with the patient sit and the hands in neutral position over the table. The ultrasound transducer was gently placed over the nail directed perpendicularly to the surface, with gel applied over the examined area to provide a correct acoustic interface. Each nail was scanned in the Grey scale mode and after using Power Doppler. For each nail we considered the following parameters: - thickness and status of the of ventral plate - thickness of the bed nail - condition of the matrix - vascularization of the matrix using Power Doppler Page 3 of 17

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5 Results In 170 nails of patients with psoriasis, 65 nails had NAPSI score>0 (clinically evident) and 105 (clinically healthy) nails had NAPSI score =0. Nails of healthy controls (Fig.1) 7 had decreased thickness of ventral plate with no deformities (7%), 20 (20%) had increased thickness of the nail bed, 3 had alteration of matrix (3%), 6 (6%) had increased vascularization signal. Nails with NAPSI >0 (Fig.2) 46 had decreased thickness of ventral plate with deformation (70,7%), 36 had increased thickness of the nail bed (55,4%), 19 had alteration of matrix (29,2%), 33 had increased vascularization signal (50,7%). In our case-study we had 18 nails with NAPSI=8 (maximum score) and 9 of these nails did not have vascularization (50%) probably due to avascular necrosis and 13 had alteration of the matrix (72,2%). Nails with NAPSI =0, (Fig.3) 21 had decreased thickness of the ventral plate (20%), 7 had increased thickness of nail bed (6,6%), 3 had alteration of the matrix (2,8%), 41 had increased vascularization signal (39%). Our study shows that the increase of thickness of the nail bed and the decrease of the thickness and deformation of the ventral plate were significantly higher (p<0,01; p<0,01) in nails with NAPSI >0, compared to nails with NAPSI= 0 in patients with onychopathy. We observed that the decreased thickness and deformation of the ventral plate and higher vascularization signal were significantly higher in nails with NAPSI=0 of psoriatic patients comparing with healthy control nails (p<0,05 p <0,01). Page 5 of 17

6 Images for this section: Fig. 1: Healthy control Fig. 2: Nails with NAPSI >0 Page 6 of 17

7 Fig. 3: Nails with NAPSI =0 Page 7 of 17

8 Fig. 4: Ultrasound 22 MHZ. NAPSI > 0 Longitudinal plane: Deformation of ventral plate Page 8 of 17

9 Fig. 5: Ultrasound 22 MHZ. NAPSI > 0 Longitudinal plane: Increased thickness of the nail bed (arrow) Page 9 of 17

10 Fig. 6: Ultrasound 22 MHZ. NAPSI > 0 Longitudinal plane: Hiper-vascularization of matrix (Power Doppler) Page 10 of 17

11 Fig. 7: Ultrasound 22 MHZ. NAPSI = 0 Longitudinal plane: Hiper-vascularization of matrix (Power Doppler). Page 11 of 17

12 Fig. 8: Ultrasound 22 MHZ. NAPSI = 0 Longitudinal plane: Decreased thickness and deformation of ventral plate (arrow) Page 12 of 17

13 Fig. 9: Ultrasound 22 MHZ. NAPSI > 0 Longitudinal plane: Increased thickness of the nail bed Page 13 of 17

14 Fig. 10: Ultrasound 22 MHZ. NAPSI=0. Longitudinal plane: Normal matrix Page 14 of 17

15 Conclusion The use of a high resolution/frequency probe allows for precise and detailed analysis of diseased nail structures, which are non-discernible to the naked eye. Given this outcome, it may help the assistant physician not only in the diagnosis but also in managing the patient. Nevertheless, further studies are required to establish if the presence of nail vascularization in normal-appearing nails of psoriatic patients is an early sign of onychopathy. Page 15 of 17

16 Personal information Ilaria Mussetto - University of Genoa - Scuola di Specializzazione in Radiodiagnostica Nicola Romano - University of Genoa - Scuola di Specializzazione in Radiodiagnostica Aldo Fischetti - University of Genoa - Scuola di Specializzazione in Radiodiagnostica Alessandro Muda - Hospital "IRCSS San Martino - IST" of Genoa Page 16 of 17

17 References 1) Gisondi P, Idolazzi L, Girolomoni. "Ultrasonography reveals nail thickening in patient with chronic plaque psoriasis" Arch Dermatol Res. 2) Guiterrez M, Filippucci E, et al. "Subclinical entheseal involvement in patient with psoriasis: an ultrasound study" Semin Arthritis Rheum. 3) Sandobal C, Carbo E, Iribas J, et al. " Ultrasound nail imaging on patients with psoriasis and psoriatic arthritis compared with rheumatoid arthritis and control subjects." 2014 J Clin Rheumatol. 4) Ash ZR, Tinazzi I, Galleo CC, et al. "Psoriasis patient with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than with normal nails" Ann Rheum Dis 5) Guiterrez M, Wortsman X, et al. "High-frequency sonography in the evaluation of psoriasis: nail and ski involvement" J Ultrasound Med. 6) M Sánchez-Regaña, P Umbert. "Diagnosis and Management of Nail Psoriasis" Actas Dermosifiliogr. Page 17 of 17