Anaïs Arbault1, Hervé Devilliers2, Davy Laroche3, Audrey Cayot1, Pierre Vabres4, Jean-Francis Maillefert5, Paul Ornetti6. 1. Service de rhumatologie, hôpital du Bocage, CHU de Dijon, 14, rue Gaffarel, 21000 Dijon, France. 2. Service de médecine interne et maladies systémiques, hôpital du Bocage, CHU de Dijon, 21000 Dijon, France. 3. CIC Inserm 1432, plateforme d'investigation technologique, CHU de Dijon, 21000 Dijon, France. 4. Service de dermatologie, hôpital du Bocage, CHU de Dijon, 21000 Dijon, France. 5. Service de rhumatologie, hôpital du Bocage, CHU de Dijon, 14, rue Gaffarel, 21000 Dijon, France; Inserm 1093, université de Bourgogne, 21000 Dijon, France. 6. Service de rhumatologie, hôpital du Bocage, CHU de Dijon, 14, rue Gaffarel, 21000 Dijon, France; Inserm 1093, université de Bourgogne, 21000 Dijon, France. Electronic address: paul.ornetti@chu-dijon.fr.
Abstract
OBJECTIVE: To determine the feasibility, reliability and validity of nails ultrasonography in psoriatic arthritis as an outcome measure. METHODS: Pilot prospective single-centre study of eight ultrasonography parameters in B mode and power Doppler concerning the distal interphalangeal (DIP) joint, the matrix, the bed and nail plate. Intra-observer and inter-observer reliability was evaluated for the seven quantitative parameters (ICC and kappa). Correlations between ultrasonography and clinical variables were searched to assess external validity. Feasibility was assessed by the time to carry out the examination and the percentage of missing data. RESULTS: Twenty-seven patients with psoriatic arthritis (age 55.0±16.2 years, disease duration 13.4±9.4 years) were included. Of these, 67% presented nail involvement on ultrasonography vs 37% on physical examination (P<0.05). Reliability was good (ICC and weighted kappa>0.75) for the seven quantitative parameters, except for synovitis of the DIP joint in B mode. The synovitis of the DIP joint revealed by ultrasonography correlated with the total number of clinical synovitis and Doppler US of the nail (matrix and bed). Doppler US of the matrix correlated with VAS pain but not with the ASDAS-CRP or with clinical enthesitis. No significant correlation was found with US nail thickness. CONCLUSION: The feasibility and reliability of ultrasonography of the nail in psoriatic arthritis appear to be satisfactory. Among the eight parameters evaluated, power Doppler of the matrix which correlated with local inflammation (DIP joint and bed) and with VAS pain could become an interesting outcome measure, provided that it is also sensitive to change.
OBJECTIVE: To determine the feasibility, reliability and validity of nails ultrasonography in psoriatic arthritis as an outcome measure. METHODS: Pilot prospective single-centre study of eight ultrasonography parameters in B mode and power Doppler concerning the distal interphalangeal (DIP) joint, the matrix, the bed and nail plate. Intra-observer and inter-observer reliability was evaluated for the seven quantitative parameters (ICC and kappa). Correlations between ultrasonography and clinical variables were searched to assess external validity. Feasibility was assessed by the time to carry out the examination and the percentage of missing data. RESULTS: Twenty-seven patients with psoriatic arthritis (age 55.0±16.2 years, disease duration 13.4±9.4 years) were included. Of these, 67% presented nail involvement on ultrasonography vs 37% on physical examination (P<0.05). Reliability was good (ICC and weighted kappa>0.75) for the seven quantitative parameters, except for synovitis of the DIP joint in B mode. The synovitis of the DIP joint revealed by ultrasonography correlated with the total number of clinical synovitis and Doppler US of the nail (matrix and bed). Doppler US of the matrix correlated with VAS pain but not with the ASDAS-CRP or with clinical enthesitis. No significant correlation was found with US nail thickness. CONCLUSION: The feasibility and reliability of ultrasonography of the nail in psoriatic arthritis appear to be satisfactory. Among the eight parameters evaluated, power Doppler of the matrix which correlated with local inflammation (DIP joint and bed) and with VAS pain could become an interesting outcome measure, provided that it is also sensitive to change.