BACKGROUND: This study aimed to report a case of bilateral anterior non-granulomatous chronic non-infectious uveitis associated with isolated nail psoriasis without articular involvement.
METHODS: A 55-year-old man with a history of open-angle glaucoma was referred to our uveitis and ocular immunology center with intraocular inflammation concordant with chronic non-infectious bilateral anterior non-granulomatous uveitis. At presentation, he had moderate inflammation in the anterior chamber bilaterally and lesions characteristic of nail psoriasis. Nail psoriasis was later confirmed by nail ultrasonography performed by a radiologist who specialized in psoriasis. Appropriate clinical and paraclinical assessments were conducted, ruling out all other possible causes of uveitis. The patient required dual systemic immunomodulatory therapy with methotrexate and adalimumab, topical anti-inflammatory drugs (steroidal and non-steroidal), and anti-glaucoma therapy to achieve satisfactory inflammatory and ocular pressure control.
CONCLUSIONS: This is the first report of non-infectious uveitis associated with nail compromise in a patient without other manifestations of psoriasis. Despite reports on the relationship between psoriatic disease and uveitis, there is insufficient information on clinical phenotypes associated with uveitis that could lead to later diagnosis and treatment of associated intraocular inflammation. Clinicians should be aware of all subtypes of psoriasis that increases a risk of developing uveitis in these patients.

暂无摘要。

Psoriatic onycho-pachydermo periostitis (POPP) is characterized by psoriatic onychodystrophy, connective tissue thickening, and periostitis of the distal phalanges (DPs), producing a drumstick-like deformity. Our aim was to present the first case of POPP treated successfully with an IL-17 inhibitor, perform a literature review of its characteristics and treatment, and explore the possible pathogenesis. We conducted a systematic review of previously presented POPP cases. We present a patient with methotrexate (MTX)-resistant treatment POPP, who had significant resolution of symptoms and inflammatory lesions on post-treatment MRI with secukinumab 150 mg. We also identified 31 cases of POPP (27 males; mean age 44.9 years) in the literature review. There was great toe involvement in 24 cases, and distal interphalangeal (DIP) involvement in 14 cases, with frequent radiographically evident damage. Seventeen of 31 patients received systematic treatment other than biologics, mostly MTX, with no satisfactory results. Anti-TNF agents were used successfully in 5 cases, mostly after disease modifying anti-rheumatic drug (DMARD) failure. Imaging studies in nail psoriasis and DIP psoriatic arthritis have shown an anatomical link among the nail, the DP bone, and the DIP joint entheses, suggesting that POPP may be a subtype of nail disease with excessive involvement of DP tissues (nail, soft tissue, enthesis, and bone). IL-17 inhibition could be an alternative therapeutic option in DMARD-resistant cases of POPP. Conventional treatment achieves modest success, but anti-TNF agents appear to be much more effective. Based on imaging studies, POPP may be a particular subtype of nail disease.

Nail involvement is frequent in patients with psoriasis, especially those with psoriatic arthritis (PsA), and can significantly impair quality of life (QoL). It is typically difficult to treat compared with skin lesions, although several conventional treatment options are available. The aim of this article is to describe our experience in the treatment of nail psoriasis with secukinumab in a case series. Fifteen patients (11 males and 4 females), with moderate-severe plaque psoriasis and nail psoriasis, eligible for systemic therapy, and received secukinumab. The Psoriasis Area and Severity Index (PASI) and body surface area (BSA) assessed cutaneous severity. Nail Psoriasis Severity Index (NAPSI) was used to evaluate nail involvement. Starting from 6 weeks after initiation of treatment with secukinumab 300 mg, a clinically significant response was observed, with progressive reduction of both skin and nail disease indexes. Average reduction of PASI was 75%, of BSA 70%, and of NAPSI 50%, at week 6. At week 12, NAPSI reduction was by 80%, of PASI 90%, and of BSA 97%. Effective treatment of both skin and nail psoriasis was obtained with secukinumab, a new approach to psoriatic patients resistant to topical therapy.

Psoriasis is a chronic inflammatory disease affecting the skin, nails, and joints. About 61% of psoriatic patients have nail involvement that can cause a significant social problem. Treating nail psoriasis is challenging but can improve the health outcomes and quality of life of patients. Treatment options available for nail psoriasis including topical therapy, intralesional injections, and systemic and biologic agents have various side effects and some benefits. Management is currently inconclusive. Intralesional injection of methotrexate in nail psoriasis was previously documented in few cases. We present a case of nail psoriasis successfully treated with low-dose intralesional methotrexate with no significant side effects in a 48-year-old psoriatic patient. Given the various side effects of conventional topical and systemic therapies limiting their use, we conclude that intralesional methotrexate injection seems to be a safe and effective treatment option for nail psoriasis. However, large controlled studies are needed.

BACKGROUND: Literature concerning clinical signs and frequency of nail psoriasis is incomplete. Recent studies focus only on signs included in the Nail Psoriasis Severity Index (NAPSI).
OBJECTIVE: We sought to describe clinical characteristics of fingernail psoriasis in comparison with healthy controls.
METHODS: We collected data on 49 patients with fingernail psoriasis who visited our outpatient department and 49 control subjects, through questionnaires and clinical examination. The disease severity was measured by the NAPSI.
RESULTS: Mean NAPSI score in patients and control subjects was 26.6 and 3.6, respectively. Most items included in the NAPSI were specific for nail psoriasis. Onycholysis and splinter hemorrhages were most frequently observed. Leukonychia was more frequent in control subjects. Longitudinal ridges and Beau lines are not included in the NAPSI but are significantly more frequently seen in patients than in control subjects.
CONCLUSIONS: Limited sample size was a limitation.
CONCLUSIONS: The NAPSI was able to discriminate patients with fingernail psoriasis from healthy control subjects. Onycholysis and splinter hemorrhages were the most prevalent fingernail changes in psoriatic patients. Leukonychia was more frequently observed in control subjects, which raises the question of whether leukonychia should remain in the NAPSI. On the other hand, longitudinal ridges and Beau lines occurred more frequently in psoriasis but are not included in the NAPSI.