XXXX and @entity48842 .

@entity1 @entity1569 @entity5149 @entity48842 @entity153 @entity158 @entity85 @entity130 @entity3582
Although some cases of spoon nails and @entity5149 are manifestations of internal disease, a significant number are completely idiopathic and of no consequence to the @entity1 . Many @entity1 have been forced to pay high insurance premiums or have been denied employment because of insignificant nail changes. When a @entity1 has spoon nails or @entity5149 , a thorough but reasonable search for a primary etiology should be made. It should be recalled that when the complete syndrome of @entity3582 is present and joint @entity158 is prominent, the possibility of a @entity153 is great. If a cause of spooning or @entity5149 is found, it should be treated. However, when the physician becomes satisfied that no associated disorder exists, he should reassure the @entity1 . In the author's experience @entity48842 is most commonly due to @entity1569 , fungus, or @entity130 . It is hypothesized that the curvature changes in spoon and clubbed nails are the result of angulation of the nail matrix secondary to connective tissue changes. The structural hypothesis presented here is largely based on observations of @entity85 . These cases have allowed visualization of the angle of the nail matrix. Both spoon nails and @entity5149 are such definite reaction patterns that there must be some common mechanism for @entity85 . Structural rules that should apply to the nail have been used. It is easy to think of multiple internal disorders producing the same connective tissue changes that alter the angle of the nail matrix. It is difficult to think of another mechanism by which internal disease could alter the bonds in hard keratin.
