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.