已发现牛皮癣中的指甲疾病与牛皮癣性关节炎（PsA）有关；然而，指甲疾病的哪种亚型与PsA具有更大的相关性尚不清楚。进行这项研究是为了探索指甲疾病的三种亚型之间的关联（点蚀，甲状腺溶解症,和角化过度）和银屑病患者的PsA。2020年1月至2021年5月期间在上海的5家皮肤科诊所就诊的银屑病患者接受了皮肤检查，接头,指甲的变化。使用多变量逻辑回归分析来测试指甲疾病亚型与PsA之间的关联强度。使用具有曲线下面积（AUC）的受试者操作特征（ROC）曲线来评估其诊断PsA的准确性。还计算了灵敏度和特异性。在1985年的牛皮癣患者中，228例(11.5%)患者被诊断为PsA，其余患者为皮肤型银屑病（PsC）。一百五十七（68.9％）PsA患者和748（42.6％）PsC患者患有指甲疾病。调整后的模型显示，指甲溶解和角化过度是唯一与PsA独立相关的指甲疾病。前向条件逐步回归模型(OR，95%CI为:2.34,1.79~4.27,p<0.01;角化过度:1.62,1.12~2.66,p=0.037)。ROC分析表明,与点蚀和角化过度相比，有更高的AUC（0.630）和敏感性（52.6％）。牛皮癣性指甲溶解和角化过度与PsA的相关性大于点蚀。临床上,有指甲溶解和角化过度的银屑病患者应进行关节炎评估。要点•牛皮癣指甲炎和角化过度,而不是点蚀，与PsA显著相关•临床上，有指甲溶解和角化过度的银屑病患者应进行关节炎评估。
Nail disease in psoriasis has been found to be associated with psoriatic arthritis (PsA); however, which subtype of nail disease holds greater relevance to PsA remains unclear. This study was performed to explore the associations between three subtypes of fingernail disease (pitting, onycholysis, and hyperkeratosis) and PsA among patients with psoriasis. Patients with psoriasis attending five dermatology clinics in Shanghai between January 2020 and May 2021 were examined for skin, joint, and fingernail changes. Multivariate logistic regression analyses were utilized to test the strength of associations between subtypes of fingernail disease and PsA. The receiver operator characteristic (ROC) curve with area under curve (AUC) was used to evaluate their accuracies in diagnosing PsA. Sensitivity and specificity were also calculated. Of 1985 patients with psoriasis included, 228 (11.5%) patients were diagnosed with PsA, and the remaining patients were cutaneous-only psoriasis (PsC). One-hundred and fifty-seven (68.9%) patients with PsA and 748 (42.6%) patients with PsC had fingernail disease. Adjusted models showed that onycholysis and hyperkeratosis were the only type of fingernail disease independently associated with PsA. This association was further confirmed by the forward conditional stepwise regression model (OR, 95% CI for onycholysis: 2.34, 1.79 to 4.27, p < 0.01; for hyperkeratosis: 1.62, 1.12 to 2.66, p = 0.037). ROC analysis showed that, compared to pitting and hyperkeratosis, onycholysis had higher AUC (0.630) and sensitivity (52.6%). The psoriatic fingernail onycholysis and hyperkeratosis hold greater relevance to PsA than pitting. Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis. Key Points • Psoriatic fingernail onycholysis and hyperkeratosis, rather than pitting, are significantly associated with PsA • Clinically, psoriatic patients with fingernail onycholysis and hyperkeratosis should be assessed for arthritis.
