Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Nail Psoriasis
Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Nail Psoriasis
The primary aim of the study is to assess the effect of methotrexate on the development of
 distal interphalangeal joint extensor tendon enthesopathy.
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.
Inclusion Criteria:

 -  Patients with psoriatic changes in nails treated at the Rheumatological Clinic in
 Olsztyn and the Clinic of Dermatology, Sexually Transmitted Diseases and Clinical
 Immunology of the University of Warmia and Mazury in Olsztyn, in whom a US examination
 revealed DIP joint extensor tendon enthesopathy

 Exclusion Criteria:

 -  Patients diagnosed with osteoarthritis of hands, those who work hard physically and
 those with changes in nails other than caused by psoriasis