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Nail and Distal Interphalangeal Joint in Psoriatic Arthritis
RAFFAELE SCARPA, ERNESTO SOSCIA, ROSARIO PELUSO, MARIANGELA ATTENO, FRANCESCO MANGUSO, ANTONIO DEL PUENTE, ANGELO SPANÒ, CESARE SIRIGNANO, ALFONSO ORIENTE, MATTEO NICOLA DARIO DI MINNO, SALVATORE IERVOLINO, and MARCO SALVATORE ABSTRACT. Objective. To study distal interphalangeal (DIP) joints in patients with psoriatic arthritis (PsA) with or without onychopathy, using magnetic resonance imaging (MRI). Methods. Twenty-three patients with PsA (9/14 F/M, median age 47 yrs), 12 with onychopathy (2/10 F/M, median age 44 yrs) and 11 without (7/4 F/M, median age 52 yrs), and 10 control subjects (5/5 F/M, median age 43.2 yrs) were enrolled. MRI of nail and distal phalanx (DP) including examination of DIP joints was carried out. MRI was performed with a surface coil in a 1.5 T device. For each selected finger, both longitudinal and axial scans were performed. The involvement of nail, DP, and DIP joint was scored. Results. Nail thickening with or without surface irregularity occurred in 95.7% of cases (100% with onychopathy and 90.9% without). MRI nail involvement was more frequent in patients with clinical evidence of onychopathy than in those without (p = 0.003). Similarly, 95.7% of patients showed MRI abnormalities of DP (100% with onychopathy and 90.9% without). MRI DP abnormalities were more marked in patients with clinical evidence of onychopathy than in those without (p = 0.009). Involvement of DIP joints was present in 34.8% of cases (58.3% with onychopathy and 9.1% without), and onychopathic patients showed marked MRI DIP joint involvement in 5 cases and mild in 2, while patients without onychopathy showed minimal changes in one case (p = 0.03). Considering the entire group of patients, MRI involvement of DIP joints was always associated with MRI DP changes, and in no case was it present alone. Conclusion. MRI nail involvement was present in almost all patients with PsA studied, even in those without clinically evident onychopathy. MRI involvement of DP always overlapped with nail involvement, since it was present in all psoriatic cases showing MRI nail involvement. In contrast, MRI DIP joint involvement was almost exclusively in a lower percentage of the patients with clinical nail involvement and was always associated with MRI DP changes. Our results suggest that DIP joint involvement is always secondary to nail and DP involvement. (First Release June 1 2006; J Rheumatol 2006;33:1315–9) Key Indexing Terms:
DISTAL INTERPHALANGEAL
JOINT
From the Department of Clinical and Experimental Medicine, Rheumatology Research Unit and the Radiology Unit, University "Federico II," and the Biostructures and Bioimaging Institute of the National Council of Research, Naples, Italy. R. Scarpa, MD, Associate Professor of Rheumatology, Department of Clinical and Experimental Medicine, Rheumatology Research Unit; E. Soscia, MD, Radiology Unit, University "Federico II"; R. Peluso, MD; M. Atteno, MD; F. Manguso, MD, PhD; A. del Puente, MD; A. Spanò, MD; A. Oriente, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Research Unit, University "Federico II"; C. Sirignano, MD, Biostructures and Bioimaging Institute of the National Council of Research; M.N. Dario Di Minno, Medical Student; S. Iervolino, Medical Student, Department of Clinical and Experimental Medicine, Rheumatology Research Unit; M. Salvatore, MD, Professor of Radiology, Biostructures and Bioimaging Institute of the National Council of Research. Address reprint request to Dr. R. Scarpa, Rheumatology Research Unit, University Federico II, via Sergio Pansini 5, 80131 Naples, Italy. E-mail: rscarpa@unina.it Accepted for publication February 22, 2006.
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