LAUSR

Nail disease is an important feature of psoriasis arthritis (PsA), and has been recognised as one of the 6 important clinical domains by GRAPPA. Little is known about how patients with PsA and nail disease compare to patients without nail disease. Nail disease has been found to associate with severe PsA.The objective of this study was to examine the association of nail disease with patient demographics and features of active psoriasis and PsA.For this cross-sectional study, data from 3 PsA cohorts was studied (St Vincent’s University Hospital Dublin, Ireland; University Hospital Kerry, Ireland; and Fatima Memorial Hospital Lahore, Pakistan). Following informed consent, patients underwent detailed skin and rheumatologic assessments including disease activity measures. Since a large number of patients were in clinical remission at the time of assessment, we made 2 documentations of reversible clinical variables (e.g., current skin scores (PASI), current nail disease, current tender and swollen joint counts, current enthesitis, current dactylitis) at the time of study entry and, through extensive medical record review, we identified patient’s maximum skin and joints disease activity scores ever documented, e.g., maximum skin scores (PASI max), TJC max, SJC max, nail disease ever, dactylitis ever, enthesitis ever. Nail disease was stratified by the presence or absence of nail psoriasis.Data on 476 PsA patients was assessed (age 53.8±10.8, PsA duration 13.9±10 years, BMI 29±5; current PASI 2.5±3.2, current TJC 1.8±2.6 years, current SJC 1.4±2.2 years; 37% of the cohort had enthesitis ever, 46% had dactylitis ever, 30.7% had current dactylitis, and 28% with current enthesitis). 63.4% (n=302) of the cohort ever had nail disease, and 45.4% (n=216) had current nail disease at the time of assessment. On univariate analysis, significant or marginally significant statistical association of current nail disease was noted with current PASI (p<0.001), enthesitis ever (p=0.004), current enthesitis (p=0.11), dactylitis ever (p=0.027), current dactylitis (p=0.07), MDA not achieved (p<0.001), current SJC (p=0.08), and current TJC (p=0.32); however, no statistical association was noted with age, gender, disease duration, smoking status, low education status.The following variables were included in multiple stepwise regression analysis: current PASI, current enthesitis, current dactylitis, current TJC, current SJC, MDA not achieved, and low education status; a significant association of current nail disease was noted with current PASI (OR 2.2, CI 1.83-2.54, p<0.001) with a borderline association of current dactylitis (OR 1.6, CI 0.94-2.58, p=0.083). When we used nail disease ever as a dependent variable in the multiple regression model using covariates of PASI max, TJC max, SJC max, dactylitis ever, enthesitis ever, MDA not achieved and low education status, a significant association of nail disease ever was noted with PASI max (OR 1.09, CI 1.01-1.17, p=0.01), TJC max (OR 1.08, CI 1.02-1.14, p=0.005) and borderline association with dactylitis ever (OR 1.74, CI 0.96-3.15, p=0.067)The presence of nail disease among patients with PsA is significantly associated with severity of skin psoriasis with only borderline associations with measures of active musculoskeletal involvement.Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, shehla farrukh: None declared., Shabnam Batool: None declared., Sadia Asif: None declared., Oliver FitzGerald Speakers bureau: Abbvie, Janssen, Pfizer, Consultant of: BMS, Celgene, Eli Lilly, Janssen, Pfizer, Grant/research support from: Abbvie, BMS, Eli Lilly, Novartis, Pfizer.