| Objectives Nail psoriasis is common in psoriatic patients and leads to significant physical and phycological impairment.However,the specific impact of nail psoriasis gained little attention in the past.To gain robust data on epidemiology and health-related quality of life(HRQo L)of nail psoriasis in Chinese Han population,and to elucidate differences between patients with nail psoriasis and without nail psoriasis.The correlations between nail psoriasis and HRQo L were studied as well.Methods The total number of participating in this study was 540.All the patients came from outpatient clinic of Shandong Provincial Hospital for Skin Diseases.The epidemiological situation of nail psoriasis included gender,age,degree of education,lifestyle,place of residence,initial onset/ recurrence,family history,duration of disease,concomitant diseases.Psoriasis severity was evaluated by the Psoriasis Area and Severity Index(PASI).The health-related quality of life(HRQo L)was assessed by three questionnaires.The first questionnaire was The Dermatology Life Quality Index(DLQI),which was used to assess the whole influence of nail psoriasis on patients.The next was the Nail Psoriasis Quality of Life Scale(NPQ10).The NPQ10 was a questionnaire to evaluate the special influence of nail psoriasis.The last one was the Hospital Anxiety and Depression Scale(HADS).The HADS was used to assess the patient's psychological state.Patients with nail psoriasis were compared with those without nail psoriasis in epidemiology,clinical characteristics and HRQo L.All the questionnaires were completed independently.Physicians recycled questionnaires on the spot after completed.Results Overall,502 cases were effective.The proportion of men and women was 58.2%(292)and 41.8%(210),respective.The mean age of patients was 37.74±13.77.The incidence of nail psoriasis was 53.4%(268).The incidence of men was significantly higher than women(59.2% vs 45.2%,P<0.01).1.The comparative results of epidemiology and clinical characteristics between nail psoriasis and without nail psoriasis.The difference was found in age,which dued to the higer propotion of old age(>70 years old).The proportion of men in nail psoriasis was significantly higher than patients without nail psoriasis(64.6% vs 50.9%,P<0.01).In lifestyle,the proportion of smoking and drinking in patients with nail psoriasis was significantly higher than patients without nail psoriasis(smoking: 37.7% vs 22.6%,P<0.01;drinking: 41.4% vs 29.1%,P<0.01).Compaired with patients without nail psoriasis,patients with nail psoriasis had higher propotion of recurrence(90.7% vs 79.1%,P<0.01),more concomitant diseases(16.4% vs 6.8%,P<0.01),longer duration of disease(46.6% vs 21.4%,P<0.01),lager affected body surface area(BSA)(88.1% vs 68.4%,P<0.01),higher PASI score(42.2% vs 12.8%,P<0.01).Patients with nail psoriasis had Seriously damaged HRQo L(DLQI: 9.0 vs 6.0;Anxiety: 6.9 vs 5.2;Depression: 6.2 vs 4.5,P<0.001,respectively).There were no difference between two groups in degree of education and family history.2.The score results of DLQI items in nail psoriasis and the relationship between nail psoriasis and epidemiology and clinical characteristics.The proportion of DLQI ?10 in group of nail psoriasis was significantly higher than patients without nail psoriasis(40.3% vs 19.7%,P<0.01).The score of every question from high-to-low in the order was as follows: psychology(1.4±0.82)> physiology(1.3±0.72)> social contact(1.08±0.90)> treatment(1.07±0.78)> dress(1.01±0.86)> daily activities(0.84±0.90)> work and study(0.66±0.82)> exercise(0.62±0.84)> personal relationship(0.59±0.78)> sexual life(0.47±0.76).According to our results,psychology is the most significant aspect of the influence on patient quality of life.In nail psoriasis,the score of women was obviously higher than men(9.67±5.46 vs 8.94±5.55,P<0.05).Patients with high degree of education had higher DLQI score.Compaired with group of affected BSA<3,the group of affected BSA?10 had higher DLQI score.The scores of recurrence and PASI?10 in nail psoriasis were significantly higher than patients without nail psoriasis.Patients of affected BSA?10 had higher DLQI score.The DLQI scores were no difference between two groups in age,lifestyle,family history and concomitant diseases.3.The score results of NPQ10 items in nail psoriasis and the relationship between nail psoriasis and epidemiology and clinical characteristics.The score of every question from high-to-low in the order was as follows: pain(0.89±0.64)>mood(0.34±0.55)>work(0.21±0.48)>house work(0.19±0.46)>get dressed more slowly(0.16±0.42)>have trouble putting on shoes and socks(0.14±0.41)>have trouble turning door key(0.07±0.25)>get dressed need help and have trouble driving car(0.03±0.18).The largest proportion of item was pain(25.9%)and the next was the mood(irritable: 24.1%).The mean score of NPQ10 was 10.93±14.25.The NPQ10 score in patients with nail fold affected was significantly higher than patients without nail fold affected(18.44±20.37 vs 9.06±11.42,P<0.01).The score of women was significantly higher than men(14.00±17.74 vs 9.25±11.63,P<0.01).The NPQ10 score in patients with PASI?10 was significantly higher than patients with PASI<10(16.33±17.90 vs 7.00±9.06,P<0.01).The NPQ10 scores were no difference in age,degree of education,lifestyle,initial onset/ recurrence,family history,duration of disease,affected BSA and concomitant diseases.4.The score results of HADS items in nail psoriasis and the relationship between nail psoriasis and epidemiology and clinical characteristics.The proportion of anxiety and depression in nail psoriasis was significantly higher than patients without nail psoriasis,respectively(anxiety score?8 : 54.1% vs 29.1%,P<0.01;depression score?8:41.8% vs 24.4%,P<0.01).The HADS score of different nail psoriasis location,age and affected BSA was discrepant,respectively.The HADS score in patients with nail fold affected was significantly higher than patients without nail fold affected(anxiety:8.06±4.72 vs 6.62±3.91,P<0.05;depression:7.31±3.89 vs 5.92±3.71,P<0.05).The HADS score in group of DLQI?10 was obviously higher than the group of DLQI<10(anxiety:9.18±3.54 vs 5.34±3.69,P<0.01;depression:4.97±3.53 vs 5.68±3.67,P<0.01).The HADS scores were no difference in gender,degree of education and lifestyle.5.The results of associated risk factors analysis.There was correlation between nail psoriasis and men,recurrence,duration of disease,affected BSA,PASI score(P<0.05);Nail psoriasis was significantly correlated with DLQI,anxiety and depression(P<0.01).Conclusions More than half of psoriatic patients(53.4%)suffered from nail involvement in china.Factors of men,recurrence,duration of disease,affected BSA and PASI score were risk parametrics leading to occurance of nail lessions.Furthermore,nail involvement was a predictor of impairment of functional and psychological states. |
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