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Table 2 Studies included in the review

From: The use of ultrasonography in the diagnosis of nail disease among patients with psoriasis and psoriatic arthritis: a systematic review

Author Year Study Design Sample characteristicsa Aim Ultrasonography assessment Ultrasonography variables reported for the nail Risk of bias
Arbault et al [26] 2017 Cross-sectional 27 patients with PsA To determine the feasibility, reliability, and validity of nail US in PsA as an outcome measure. • ESAOTE MyLab 70 XVG fitted with a high frequency transducer of 22 mHz. (PRF: 500 Hz, Doppler frequency: 6.3 MHz, Gain: 30%) • Nail bed thickness
• Nail plate thickness
High
Severity level: NR
Duration (mean): 13.4 ± 9.4 years
Age (mean): age 55 ± 16.2 years
Female:40.74 %
Aydin et al [27] 2017 Cross-sectional 86 patients with PsO and 19 healthy controls To find the frequency and severity of PD signals in psoriatic nail disease compared with healthy controls to understand whether PD signals are associated with disease. • Logiq E9 machine (General Electric, Wauwatosa, WI, USA)
• Linear probe at 10–18 MHz
• PD settings: pulse repetition frequency of 800 Hz, a Doppler frequency of 9.1, and low wall filters
• PD changes on the nail bed Moderate
Severity level: NR
Duration (mean): NR
Age (mean): NR
Female: NR
Fassio et al [28] 2017 Case-control 82 cases (31 PsO, 51 PsA, and 50 controls) To evaluate the presence of the nail involvement and subclinical alterations using US in PsO and PsA. • Not informed • Nail bed thickness
• Nail plate thickness
Moderate
Severity level: NR
Duration (mean): NR
Age (mean): NR
Female: NR
Paramalingam et al [29] 2017 Cross-sectional 10 patients with PsA To investigate the nail bed changes seen in patients with PsA and OA using US and MRI, and to determine the impact of nail bed changes on quality of life. • Not informed • Pitting
• Nail structural abnormalities
• Trilaminar appearance
High
Severity level: NR
Duration (mean): NR
Age (mean): 55.0 (48.0–63.2) years
Female: NR
Acquitter et al [30] 2016 Cross-sectional 37 patients with PsO (18 with nail disease and19 with scalp PsO and/or inverse PsO) To detect subclinical entheses and nail abnormalities using gray-scale and PD US between patients with nail PsO and those with inverse and scalp PsO. • IU 22 machine (Philips) and a linear probe at 12.5 MHz (PRF = 500 Hz) • Nail matrix thickness
• PD signal in nail bed
• Trilaminar appearance
High
Severity level: NR
Duration (mean): (years/SD) 13.28/10.34 Nail psoriasis 17.11/13.14; Inverse and scalp psoriasis
Age (mean): 47.61 (15.88) years Nail psoriasis; 47.11 (12.65) years Inverse and scalp psoriasis
Female: 44.44% Nail psoriasis; 63.15% Inverse and scalp psoriasis
Marina et al [31] 2016 Case-control 23 cases with PsO and 11 controls To evaluate both the morphologic appearance and blood flow changes in the nail apparatus of patients with PsO compared with disease-free controls using gray-scale and color and PD HRUS. • Transducer ranging from 8–40 MHz (focal range 0.2–3 cm, image field 16 mm) – nail anatomy
• Hitachi EUB 8500 System with a variable-frequency transducer ranging from 6.5–13 MHz – blood flow
• Doppler (color Doppler: PRF 500–1000 Hz, wall filter 25–50 Hz, PD: PRF 350–700 Hz, wall filter 22–50 Hz; color and PD)
• Esaote US machine with 18 MHz – morphostructural changes
• Ventral nail plate deposits
• Nail plate aspect
• Color Doppler spots
• PD spots
• Nail bed thickness
• Nail plates thickness
• Nailfold vessel RI
High
Severity level: moderate-to-severe chronic plaque psoriasis
Duration (mean): lasting at least 6 months
Age (mean): 52.43±14.28SD years
Female: 21%
Mendonça et al [32] 2015 Case-control 44 cases (PsA and 16 controls (10 healthy controls, 6 OA) To compare PD and SD US indexes (semiquantitative gray-scale and PD scores) and RI in the nails of patients with PsA and their controls. • PD and SD techniques with frequency ranging from 6–8 MHz • RI High
Severity level: NR
Duration (mean): NR
Age (mean): NR
Female: NR
El Miedany et al [33] 2014 Case-control 126 cases (PsO) and 112 controls To identify the clinical predictors of arthritis in patients with PsO and to evaluate the use of musculoskeletal US as a predictor for inflammatory structural progression consistent with early PsA in psoriatic patients, using rheumatologic evaluation as the gold standard for diagnosis. • Multi-frequency linear array 14–21 MHz transducer;
• Gray-scale and PD techniques.
• Trilaminar appearance Moderate
Severity level: PASI 12.4±10.4
Duration (mean): 4.8±3.1 mo
Age (mean): 35.9±8.7 years
Female: 43.4%
Mendonça et al [34] 2014 Case-control 28 cases (PsA) and 7 controls To assess the RI in the nail bed in longitudinal and transverse planes and correlate with the presence of PD in the nail bed, change in standard trilaminar appearance of the nail, measure of the nail bed, and clinical measurements. • Esaote US machine , with 6–18 MHz broadband multifrequency linear transducer
• Doppler frequency ranging from 7.1–14.3 MHz
• RI in the nail bed in longitudinal plane
• RI in the nail bed in transverse plane
• PD in the nail bed
• Trilaminar appearance
• Nail bed thickness
High
Severity level: PASI 6.03±12.27
Duration (mean): 10.05±10.49 mo
Age (mean): 45.3±14.61 years
Female: 54.5% women
Sandobal et al [35] 2014 Case-control 35 cases with PsA, 20 with PsO, 28 healthy subjects, and 27 with RA To show findings at finger nails level revealed by high-frequency gray-scale US and PD in patients with PsA, and cutaneous PsO compared with RA and control subjects. • MyLab 25 XVG system with a variable-frequency transducer ranging from 10–18 MHz
• Doppler frequency ranging from 6–8 MHz
• Wortsman typology
• PD signal in nail beds
• Nail thickness
High
Severity level: PASI 3
Duration (mean): 9±1.6 mo
Age (mean): 51±13 years
Female: NR
Aydin et al [36] 2013 Case-control 5 cases with PsO, 13 with PsA and 12 controls To compare optical coherence tomography US for nail disease assessment in psoriatic disease. • Logiq E9 machine with a linear probe at 9–14 MHz
• Multiplanar technique
• Gray-scale technique
• Trilaminar appearance
• Pitting
High
Severity level: NR
Duration (mean): NR
Age (mean): NR
Female: NR
Aydin et al [37] 2012 Case-control 86 cases (PsO) and 20 controls To compare US with the modified NAPSI, to investigate the nail plate, nail matrix, and adjacent tendons in subjects with psoriatic nail disease and to test the hypothesis that nail involvement was specifically linked to extensor tendon enthesopathy. • Logiq E9 machine with a linear probe at 18–10 MHz
• Gray-scale technique - frequency at 14 MHz, gain at 18 dB, and a dynamic range at 36 dB
• Pitting
• Nail thickness
• Nail matrix
Moderate
Severity level: mNAPSI 15
Duration (mean): 16 mo
Age (mean): NR
Female: 38.4%
Gisondi et al [38] 2012 Case-control 138 cases (PsO) and 83 controls To estimate nail involvement in patients with chronic plaque PsO using US. • Voluson I portable US machine (General Electrics, United States) with linear 10–18 MHz probe equipped with a variable-frequency transducer of 18 MHz
• Gray-scale technique
• Thickening of the nail plate
• Sub-nail hyperkeratosis
• Pitting
Moderate
Severity level: NAPSI 18.4 ± 17.5
Duration (mean): 20 ± 12 mo
Age (mean): |NR
Female: 15%
Haddad et al [39] 2012 Case-control 10 PsA cases, 10 PsO cases, and 20 controls To investigate the association between clinical and ultrasonographic features of psoriatic nail disease and to identify specific nail features associated with PsA. • 10-MHz linear array transducer
• Doppler signal standardized with a pulse repetition frequency of 400 Hz, a gain of 20 dB, and a low wall
• Loss of definition of the ventral plate
• Hyperechoioc focal involvement of the ventral plate
• Thickening of both the and dorsal and ventral plates
• Nail bed thickness
• Nail matrix thickness
• Nail bed vascularity
• Nail matrix vascularity
High
Severity level: NR
Duration (mean): 21.1 ± 11.7 mo
Age (mean): 54.7 ± 12.6 years
Female: 22.2%
El-Ahmed et al [40] 2011 Case-control 23 PsO cases (16 with nail disease and 7 without) and 23 controls To evaluate the vascularity in the nails of patients with PsO treated with classic and biologic therapies for comparison with disease-free controls, and to evaluate whether there are differences in nail vascularity among patients with and without nail involvement. • Echo Doppler examination • Nailfold vessel RI High
Severity level: NR
Duration (mean): NR
Age (mean): 42 years
Female: 34.78%
Gutierrez et al [41] 2010 Pictorial essay 30 cases (PsA) To show the main high-frequency gray-scale US and PD findings in patients with PsA at joint, tendon, enthesis, skin, and nail level. • MyLab 70 XVG with 6–18 MHz broadband multifrequency linear transducer and Doppler frequency ranging from 7.1 to 14.3 MHz
• Technos “Partner” System with 8–14 MHz multifrequency linear band transducer and Doppler frequency ranging from 8.3–12.5 MHz
• Logiq with 8–15 MHz multifrequency linear transducer
• Hyperechoic definition of the nail plate
• Fusion of nail plate
• Thickening of nail plate
• Nail bed
• Blood flow
High
Severity level: PASI 12.4
Duration (mean): NR
Age (mean): NR
Female: NR
Gutierrez et al [42] 2009 Case-control 20 cases (PsO) and 10 controls To show the main sonographic findings obtainable with “last-generation” high-frequency transducers and PD technique in patients with PsO. • MyLab 70 XVG with a variable-frequency transducer ranging from 6–18 MHz • Only descriptive approach of morphologic characteristics of nail;
• Nail homogeneity
• Trilaminar aspect
• Nail bed
• Blood flow
High
Severity level: NR
Duration (mean): NR
Age (mean): 32-52 years
Female: 65%
Gutierrez et al [43] 2009 Case-control 30 cases (PsO) and 15 controls To show the potential of the latest sonographic equipment using high-frequency probes and a very sensitive PD technique in depicting both skin and nail changes in patients affected by PsO. • MyLab 70 XVG system with a variable-frequency transducer ranging from 6–18 MHz and a Doppler frequency ranging from 7–14 MHz
• Gray-scale – to detect mosphostructural changes
• PD to detect abnormal blood flow
• SD to confirm PD signal
• Nail plate
• Nail bed
• Thickening measurement
• Blood flow
High
Severity level: PASI 12.3
Duration (mean): 20 mo
Age (mean): 46 years
Female: 40%
  1. Studies reported as abstracts: Fassio et al (2017) [28], Paramalingam et al (2017) [29], Mendonça et al (2015) [32], Mendonça et al (2014) [34], and Haddad et al (2012) [39]
  2. aCases indicate the number of patients with an actual diagnosis, as compared to healthy controls, and only data for patients is presented; HRUS=high-resolution ultrasonography; MRI Magnetic resonance imaging, NAPSI Nail Psoriasis Severity Index, NR Not Reported, OA Osteoarthritis, OCR Optical coherence tomography, PD Power Doppler, PASI Psoriasis Area Severity Index, PsA Psoriatic arthritis, PsO Psoriasis, RA Rheumatoid arthritis, RI Resistive Index, SD Spectral Doppler, US Ultrasonography