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Figure1Questions

What can pits and spots in nails predict?

A 30-year-old reports discoloration and dystrophic changes of several nails on their hands bilaterally for the last six months. They deny any ocular symptoms, back pain or gastrointestinal symptoms, but report having an itchy, scaly rash in the armpits and groin six months back, that resolved after using a topical steroid cream. Patient denies any joint pain or swelling. Reports a family history of ankylosing spondylitis (HLA-B27+) in their father.

Which of the following clinical manifestations are they at high risk for developing?