Fingernail changes may predict more serious forms of systemic sclerosis
Fingernail changes are predictors of more severe forms of systemic sclerosis (SSc) characterized by digital microangiopathy, including digital ulcers and calcinosis cutis, according to a recent study.
Researchers conducted a case-control study involving 129 patients with SSc and 80 healthy control participants who underwent routine fingernail examination to determine the prevalence of fingernail changes in SSc and to evaluate the association between fingernail changes and other features of SSc.
Fingernail changes in SSs had a prevalence of 80.6 percent. Compared with healthy control participants, patients with SSc were more likely to have trachyonychia (p=0.006), scleronychia (p<0.0001), thickened nails (p<0.0001), brachyonychia (p=0.0004), parrot beaking (p<0.0001), pterygium inversum unguis (p<0.0001), splinter haemorrhages (p<0.0001) and cuticle abnormalities (p<0.0001).
The presence of fingernail changes showed an association with digital ulcers (p<0.0001), calcinosis cutis (p=0.004) and higher values of mean nailfold videocappillaroscopy score (p=0.0009).
“Nail changes should be systematically checked in all patients with SSc, and may be included in the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc,” according to researchers.
The study was limited by its cohort that originated from a single centre.
In connective tissue diseases (CTDs), the most important site of affection is the promixal nailfold. Specifically, splinter haemorrhages (p<0.05) and capillary loops in proximal nailfold (p<0.01) in fingernails were common in patients with SSc. Fingernail changes can thus be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis, according to a previous study that assessed the frequency and the specificity of fingernail changes associated with CTDs. [J Eur Acad Dermatol Venereol 2007;21:497-503]