Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Nail Psoriasis
Condition: Nail Psoriasis
MeSH terms: Enthesopathy; Psoriasis
Study type: Observational

Summary: 
      The primary aim of the study is to assess the effect of methotrexate on the development of
      distal interphalangeal joint extensor tendon enthesopathy.
    

Detailed description: 
      Nail psoriasis is one of the risk factors for psoriatic arthritis (PsA), especially with
      distal interphalangeal joints affected. Nail changes in psoriasis have been observed in
      10-55% of patients, and the nail psoriasis-related inflammation can spread to adjacent
      structures, including DIP joints and digital extensor tendons. Enthesopathies are among the
      characteristic features of psoriatic arthritis. In everyday practice, assessment of psoriatic
      changes in nails is based mainly on clinical indices, such as nail psoriasis severity index
      (NAPSI) and modified NAPSI (mNAPSI), while imaging examinations, such as ultrasonography are
      performed much less frequently.

      The findings of this study may assess the reasonableness of systemic treatment of nail
      psoriasis in patients without arthritis as enthesopathy prevention as well as the usability
      of US nail examinations in Ps and PsA patients in assessment of morphological changes and a
      response to treatment.

      A US examination of nails and distal interphalangeal joint extensor tendons are conducted in
      all of the patients twice at an interval of six months. The examination is conducted by a
      rheumatologist experienced in ultrasound examinations of the skeletal and muscular system. An
      assessment of the nails, extensor tendons and DIP joints is made by placing the head on the
      dorsal side. In order to avoid pressure on surface tissues, an appropriate amount of gel
      without gel pads was used. The intensified blood flow, made visible by the PD technique, is
      confirmed by pulsed wave Doppler spectrum. The nail thickness is measured as the maximum
      distance between the dorsal and ventral nail plates. The nail bed thickness is measured as
      the distance between the ventral plate and the bone margin of the distal phalanx. The nail
      matrix thickness is measured at the proximal end of the nail bed.

      The study was approved by the Bioethics Committee of the Warmia and Mazury Chamber of
      Physicians The study are conducted according to the Good Clinical Practice guidelines. Each
      participant signs an informed consent and be coded with unique ID.

      Results of analyses will be saved by indexing with ID code only, personal data with
      individual IDs will be saved in additional file. All hard copy will be archived in secure
      room with coded electronic key.
    

Intervention name(s): Methotrexate
Intervention type(s): Drug
Intervention description(s): Methotrexate in the treatment of distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis
Other intervention name(s): Methotrexate Ebeve, Metex,
Intervention MeSH terms: Methotrexate
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with psoriatic changes in nails with distal interphalangeal extensor tendon
        enthesopathy in ultrasound examination
      
Biospecimen description: 
      blood probes for laboratory test
    
Keywords: Distal Interphalangeal Joint Extensor Tendon Enthesopathy; Nail Psoriasis