Abstract
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO).
Highlights
Dactylitis is a pathognomonic manifestation of psoriatic arthritis (PsA) and a diagnostic criterion in the ClASsification for Psoriatic ARthritis (CASPAR) [1,2]
Compared to rheumatoid arthritis (RA), psoriasis, and healthy controls, PsA fingers demonstrate a high prevalence of US-determined periarticular soft tissue alterations, at flexor tendon pulleys [15,16,17]
Fifteen patients developed more than one episode of dactylitis; no patient presented with two or more symptomatic fingers simultaneously nor had multiple episodes involving the same finger
Summary
Dactylitis is a pathognomonic manifestation of psoriatic arthritis (PsA) and a diagnostic criterion in the ClASsification for Psoriatic ARthritis (CASPAR) [1,2]. Dactylitis has variable associations to inflammatory lesions, including flexor tenosynovitis (FT), soft tissue oedema (STO), and joint synovitis [10]. These pathophysiological features of dactylitis can only be appreciated with advanced imaging with musculoskeletal-ultrasound (Msk-US) and magnetic resonance imaging (MRI) studies [11,12,13,14]. A recent study showed that high values of LDI-b (indicating more disease) are associated with FT and STO on US [21] The results of these cross-sectional studies suggest that FT and STO could play a role in triggering and sustaining the local symptoms of dactylitis
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