Distal Erosions and Nail Psoriasis

Hospices Civils de Lyon104 enrolled

Overview

Nearly 30% of patients with cutaneous psoriasis (PsO) developed psoriatic arthritis (PsA). Among these patients 20 % will have severe destructive arthritis. The risk of developing PsA is significantly higher in patients with nail involvement (OR = 2.24; 95% CI \[1.26-3.98\]). The risk is particularly high for the peripheral form of PsA and onycholysis (OR=2.80; 95% CI \[1.34-5.85\]). Thus the investigators wanted to test the hypothesis that onycholysis, in patients without PsA, is a potential clinical marker of subclinical distal enthesopathy and, by extension, of bone micro-structural alterations. Patients and Methods The investigators will recruit 4 groups of subjects: 1. Patients with peripheral PsA, 2. Patients with psoriatic nail onycholysis, 3. Patients with PsO only 4. Healthy match control subjects. The investigators will assess the presence of enthesopathy by ultrasonography and bone structural damages (by HR-pQCT) in all subjects at baseline and 4 years.

Study Type

OBSERVATIONAL

Enrollment

104

Conditions

Psoriatic Arthritis

Interventions

HR-pQCT High resolution peripheral quantitative CT-scanRADIATION

HR-pQCT is a powerful device providing low dose irradiation already used in bone field. It is a high resolution tool (voxel size=82µm) that the investigators adapted to look after the distal joint involved by onycholysis. An anteroposterior scout view is used to define the region of interest (ROI), which spanned from the top of the distal phalange to the distal part of the intermediate phalange in order to contain the distal joint of the target finger. Images are then analysed for erosions, osteophytes and volumetric bone mineral density.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * adults over 18 years and until 65 years * both gender * covered by the French National Insurance * subjects entering one of the 4 groups. Exclusion Criteria: * Treatment by biological agents are an exclusion criteria for PsO, onycholysis and control patients. * Pregnant women

Outcomes

Primary Outcomes

distal phalangeal bone erosion of the 2 index fingers of the hand

assessment by HR-pQCT

Time frame: at baseline and after 4 years of follow-up

Secondary Outcomes

enthesopathy of the 2 index fingers of the hand

assessment by ultrasonography

Time frame: at baseline and after 4 years of follow-up

Rheumatoid factors

Time frame: Biomarkers are assessed at baseline

Central Contacts

Cyrille Confavreux, MD PHD

CONTACT

(0)4 72 11 74 79 cyrille.confavreux@chu-lyon.fr

Céline Coutisson, clinical research assistant