Nailfold capillary abnormalities may be early indicator of pustulotic arthro-osteitis
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Key takeaways:
- Nailfold capillary changes in patients with palmoplantar pustulosis may indicate pustulotic arthro-osteitis (PAO).
- More patients with vs. without PAO had nailfold bleeding and enlarged capillaries.
Nailfold capillary abnormalities may be useful for early therapeutic intervention of pustulotic arthro-osteitis in patients with palmoplantar pustulosis, according to a study.
“Palmoplantar pustulosis (PPP) is one of the most common chronic inflammatory skin diseases,” Takemichi Fukasawa, MD, PhD, of the Psoriasis Center and department of clinical cannabinoid research at the University of Tokyo Graduate School of Medicine, and colleagues wrote. “It is accompanied by a variety of complications that have a significant impact on the prognosis of patients.”
One of these complications is pustulotic arthro-osteitis (PAO), a condition that leads to a life-altering diagnosis of osteoclastic arthritis.
Studies estimate that the incidence of PAO in patients with PPP ranges from 10% to 45%. Dermatologists play a large role in diagnosing PAO as the disease tends to have cutaneous manifestations, one of which may be nailfold capillary (NFC) changes.
In this study, researchers evaluated the clinical significance of NFC changes in patients with PPP to see if this manifestation can indicate PAO.
Of 102 patients with PPP in the study, 50 had PAO. Results showed that, compared with patients without PAO, a significantly larger proportion of patients with PAO had nailfold bleeding (50% vs. 92%; P < .0001) and enlarged capillaries (50% vs. 94%; P < .0001).
According to a multivariate analysis, NFC abnormalities may be predictors of PAO development (HR = 3.37; 95% CI, 1.13-10.07).
Furthermore, scores on the Composite Palmoplantar Pustulosis Disease Activity Index positively correlated with the degree of NFC abnormalities. This suggests that the number of NFC abnormalities reflects the severity of PAO, according to the researchers.
Guselkumab proved to significantly reduce the progression of PAO in patients with PPP without PAO, reducing the risk for developing PAO by less than 0.1-fold.
“NFC abnormalities, which are easily observed in clinical practice, would be useful for early therapeutic intervention for PAO,” Fukasawa and colleagues wrote.
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