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Short report
MRI of psoriatic nail disease pre- and post-TNF inhibitor therapy shows persistent subclinical inflammation after 6 months despite good clinical response
  1. Zoe Ash1,2,
  2. Ai Lyn Tan1,2,
  3. Richard J Hodgson1,2,
  4. Andrew Grainger1,2,
  5. Helena Marzo-Ortega1,2 and
  6. Dennis G McGonagle1,2
  1. 1 Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  2. 2 NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Professor Dennis G McGonagle; d.g.mcgonagle{at}

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Key messages

What is already known about this subject?

  • Nail involvement is part of the clinical spectrum of psoriatic arthritis and responds to tumour necrosis factor (TNF) inhibitors.

What does this study add?

  • This small study assessed patients with psoriatic arthritis with nail disease and active distal interphalangeal (DIP) arthritis before and after 6 months of TNF inhibitor treatment.

  • Persistent inflammatory changes in and around the DIP joint were seen on follow-up MRI scans despite a good clinical response.

How might this impact on clinical practice?

  • Further studies are needed to see whether these inflammatory changes resolve with a longer duration of treatment or relate to radiographic progression of the arthritis.

Nail involvement is part of the clinical spectrum of psoriatic disease and is microanatomically associated with distal interphalangeal joint (DIPJ) entheses.1 Tumour necrosis factor (TNF) inhibitors have shown efficacy for psoriasis, arthritis, enthesitis, dactylitis and nail disease.2 Given the intimate links between psoriatic arthritis (PsA) and nail disease, it might be expected that nail disease improvement would be associated with resolution of the underlying arthropathic features.

All participants gave written consent. All cases fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria for PsA.3 All cases were due to …

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