Do Nails Tell a Pulmonary Tale? A Cross-Sectional Study on Psoriasis and Pulmonary Hypertension Risk

Background: Psoriasis is a systemic inflammatory disease associated with cardiopulmonary comorbidities. Nail psoriasis, quantified by the Nail Psoriasis Severity Index (NAPSI), is a marker of severe disease. While pulmonary arterial hypertension (PAH) is reported more frequently in psoriasis, the specific correlation between nail psoriasis severity and PAH remains underexplored. Objective: To investigate the correlation between NAPSI scores and the presence or severity of PAH in patients with psoriasis. Methods: A prospective, cross-sectional study was conducted at a tertiary care centre involving 100 patients with chronic plaque psoriasis (50 with and 50 without nail psoriasis). All participants underwent dermatological evaluation [Psoriasis Area and Severity Index (PASI) and NAPSI scoring], transthoracic echocardiography to estimate pulmonary artery systolic pressure (PASP), and measurement of inflammatory markers [C-reactive protein (CRP), IL-17, TNF-α]. PAH was defined as PASP > 35 mmHg. Statistical analyses included correlation tests, comparative analyses, and multivariate logistic regression. Results: PAH was identified in 29% (n = 29) of patients, with a significantly higher prevalence in the nail psoriasis group (40% vs 18%, P = .01). Patients with PAH had higher mean NAPSI scores than those without (29.5 ± 13.4 vs 18.2 ± 10.6, P = .001). A moderate positive correlation was found between NAPSI scores and PASP ( r = 0.44, P < .001). PASI scores and CRP levels were also significantly elevated in patients with PAH and correlated with PASP ( r = 0.38, P = .001 and r = 0.41, P < .001, respectively).Multivariate analysis confirmed NAPSI score as an independent predictor of PAH [odds ratio (OR): 1.07/unit increase, 95% CI: 1.03-1.11, P = .002], after adjusting for confounders including PASI score and comorbidities. PASI (OR: 1.05, P = .01) and CRP (OR: 1.13, P = .008) were also independent predictors. Nail matrix involvement was more strongly associated with PAH than nail bed involvement ( P = .03). Inflammatory markers (CRP, IL-17, TNF-α) were significantly elevated in patients with PAH. Conclusion: NAPSI scores, PASI scores, and CRP levels are all significantly correlated with and independently predict PAH in patients with psoriasis. Assessment of nail psoriasis severity may serve as a valuable, noninvasive clinical tool to identify psoriasis patients at increased risk of pulmonary vascular complications, warranting further cardiological evaluation.