Nail psoriasis in PsA linked to more severe symptoms, worse quality of life
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Patients with nail psoriasis alongside psoriatic arthritis demonstrate worse disease activity, quality of life and work productivity than those without nail involvement, according to data published in The Journal of Rheumatology.
“Although nail disease is an important feature of PsA, little is known about how patients with PsA and nail disease differ from those without nail disease with respect to patient and clinical characteristics and disease burden,” Philip J. Mease, MD, of Swedish Medical Center and the University of Washington, in Seattle, and colleagues wrote. “A better understanding of the burden of nail disease in patients with PsA may help raise awareness of the importance of assessing nail involvement in patients with PsA and affect treatment choices.”
“In patients with psoriasis (without PsA), nail involvement is associated with higher psoriasis disease severity, including a higher percentage of affected body surface area (BSA) and worse Psoriasis Area and Severity Index (PASI) scores more pain and psychological distress, reduced [Health Related Quality of Life (HRQOL)], and substantial functional impairment and disability,” they added. “However, limited data are available regarding the burden of nail disease in PsA.”
To analyze the links between nail psoriasis and disease activity, quality of life and work productivity among patients with PsA, Mease and colleagues examined data from the Corrona PsA/Spondyloarthritis Registry. The researchers included a total of 2,841 patients with PsA who enrolled in the registry between March 2013 and October 2018 and had data on physician-reported nail psoriasis. These patients were then stratified by the presence or absence of nail psoriasis at enrollment.
Mease and colleagues compared demographic data, disease activity, quality of life and work productivity at enrollment for all included patients. Data were compared between those with and without nail psoriasis using t-tests or Wilcoxon rank-sum tests for continuous variables, and chi-square or Fisher exact tests for categorical variables.
According to the researchers, 1,152 of the included patients — or 40.5% — demonstrated nail psoriasis. Among those with nail psoriasis, 51.9% were men and 12.3% were disabled from working (all P < 0.05). Meanwhile, among those without nail involvement, 44.1% were men and 7.8% were disabled from working (all P < 0.05).
In addition, patients with nail psoriasis experienced higher disease activity, including higher tender and swollen joint counts, worse Disease Activity Index for Psoriatic Arthritis and Psoriatic Arthritis Disease Activity Score values, and an increased likelihood of having enthesitis and dactylitis, than those without (all P < 0.05). Those with nail psoriasis also demonstrated worse pain, fatigue, and work and activity impairment than those without nail enthesitis involvement (all P < 0.05).
“Overall, the results of this study highlight the burden of nail psoriasis in patients with PsA,” Mease and colleagues wrote. “Nail psoriasis was associated with greater severity of psoriasis and PsA symptoms, more disability and functional impairment, and worse HRQOL. These findings emphasize the importance of identification and management of nail disease in patients with PsA. Further research is needed to assess whether nail disease affects treatment response in patients with PsA.”
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