Gurjit S Kaeley1, Lihi Eder1, Sibel Zehra Aydin1, Phoebe Rich1, Catherine J Bakewell1. 1. This study is funded by Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA. 1G.S. Kaeley, MRCP, Department of Medicine, University of Florida College of Medicine, Division of Rheumatology, Jacksonville, Florida, USA; L. Eder, MD, PhD, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada; S.Z. Aydin, MD, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada; P. Rich, MD, Oregon Dermatology & Research Center, Portland, Oregon, USA; C.J. Bakewell, MD, Salt Lake Clinic, Salt Lake City, Utah, USA. GSK has received consultancy fees from Novartis. LE received research and educational grants or consultancy fees from AbbVie, Amgen, Pfizer, Janssen, Eli Lilly, Novartis, and Celgene. SZA has received consultancy fees from AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. PR has received research funding from AbbVie, Bristol Myers Squibb, Cellceutix (now Innovation Pharmaceuticals), Eli Lilly, Kadmon Holdings, Sun Pharma/ Merck, and UCB. CJB has received consultancy fees from and/or served on speakers bureaus for AbbVie, Novartis, Pfizer, and Sanofi Genzyme/ Regeneron. Address correspondence to Dr. G.S. Kaeley, University of Florida College of Medicine, Division of Rheumatology, 653-1 West 8th St, LRC 2nd Floor L-14, Jacksonville, FL 32209-6561, USA. Email: Gurjit.Kaeley@jax.ufl.edu. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.
Abstract
OBJECTIVE: An estimated 40-50% of patients with psoriasis (PsO) have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (PsD; e.g., enthesitis, arthritis) and we review targeted therapies for nail PsO (NP). METHODS: We performed a literature search to identify which systemic therapies approved for the treatment of PsO and/or psoriatic arthritis (PsA) have been evaluated for the treatment of NP, either as a primary or secondary outcome. A total of 1546 articles were identified on February18, 2019, and evaluated for relevance. RESULTS: We included findings from 66 articles on systemic therapies for the treatment of NP in PsD. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Area Severity Index, there was a high level of methodological heterogeneity across studies. CONCLUSION: NP is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat NP to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized NP scoring systems and well-defined treatment guidelines to improve management of PsD.
OBJECTIVE: An estimated 40-50% of patients with psoriasis (PsO) have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (PsD; e.g., enthesitis, arthritis) and we review targeted therapies for nail PsO (NP). METHODS: We performed a literature search to identify which systemic therapies approved for the treatment of PsO and/or psoriatic arthritis (PsA) have been evaluated for the treatment of NP, either as a primary or secondary outcome. A total of 1546 articles were identified on February18, 2019, and evaluated for relevance. RESULTS: We included findings from 66 articles on systemic therapies for the treatment of NP in PsD. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Area Severity Index, there was a high level of methodological heterogeneity across studies. CONCLUSION: NP is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat NP to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized NP scoring systems and well-defined treatment guidelines to improve management of PsD.