Subject(s)
Arthritis, Psoriatic/diagnosis , Pain Measurement , Severity of Illness Index , Female , Humans , MaleABSTRACT
OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) commonly have nail involvement. There is no validated psoriatic nail assessment tool. Recently, investigators developed the Nail Psoriasis Severity Index (NAPSI). Beginning with NAPSI, our goal was to validate a psoriatic nail assessment tool for use in clinical trials, and investigate correlations between nail and other PsA features. METHODS: Fingernails of 29 patients with PsA were photographed and scored. Clinical data were collected. Using the original NAPSI, analysis revealed high interrater variability of nail scores. Twenty patients' photographs were regraded using the modified NAPSI (mNAPSI). RESULTS: The mNAPSI scores had excellent interrater reliability (Cronbach's alpha 0.98). Nail scores and physicians' global nail severity visual analog scores showed good inter- and intrarater correlations (Spearman's rho 0.85 and 0.90-0.99, respectively; p < 0.01). Several clinical measures correlated with nail scores. CONCLUSION: The mNAPSI demonstrated excellent interrater reliability and construct validity, and may be a valuable tool.
Subject(s)
Arthritis, Psoriatic/complications , Nail Diseases/etiology , Nail Diseases/pathology , Severity of Illness Index , Adult , Aged , Arthritis, Psoriatic/pathology , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Nail involvement is common in patients with psoriasis and psoriatic arthritis, affecting 80%-90% of patients at some time. It also has significant effects on quality of life. Psoriatic nail disease can be refractory to treatment, and different features may respond variably to different therapies. The lack of standardized outcome assessments hinders the interpretation of available data. In this systematic evidence-based review of the literature, we assess various treatments for psoriatic nail disease.
Subject(s)
Arthritis, Psoriatic/drug therapy , Drug Therapy , Nail Diseases/drug therapy , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/pathology , Drug-Related Side Effects and Adverse Reactions , Humans , Nail Diseases/complications , Nail Diseases/pathology , Quality of Life , Randomized Controlled Trials as Topic , Severity of Illness Index , Treatment OutcomeABSTRACT
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy characterized by the association of arthritis and psoriasis. PsA runs a variable course, from mild synovitis to severe, progressive, erosive arthropathy. The pathogenesis of PsA involves alteration in the components of the immune response, although the exact cause of PsA is unknown. A number of patients with severe peripheral arthritis fail to respond to standard conventional therapy. Advances in biotechnology and in our understanding of the immunopathogenesis of PsA have led to great interest and progress in regards to biologic treatments for PsA. Notable success achieved with recently introduced biologic therapies has paved the way for further research and development of additional therapies that should improve outcomes for affected patients.
ABSTRACT
Psoriatic arthritis (PsA) is an important condition that significantly impacts affected patients. The introduction of novel therapeutic agents for PsA has generated great interest in clinical trials as well as in clinical care. Therefore, there is a great need for standardized outcome measures that can accurately assess the activity of disease and response to therapy. Because it is a heterogeneous and multifaceted condition, defining outcome measures has been a challenge. To date, such measures have largely been adapted from other similar diseases. With further research, the most appropriate outcome measures specific for PsA will be delineated.
