Abstract
Objective: To determine the prevalence of grey scale and power Doppler (PD) ultrasound (US) features of A1 pulley inflammation in a cohort of psoriatic arthritis (PsA) patients compared with rheumatoid arthritis (RA) patients.Methods: Sixty patients (30 with PsA and 30 with RA) were consecutively enrolled. The main clinimetric indexes were recorded, and US assessment of A1 pulleys from second to fifth fingers bilaterally was carried out. The presence of A1 pulley inflammation, defined as PD signal within a thickened pulley, was registered.Results: A1 pulley inflammation was found in 15 of 240 fingers (6.3%) of eight PsA patients (26.7%) and in one of 240 fingers (0.4%) of one RA patient (3.3%) (p < 0.01 and p = 0.03, respectively). Seven of eight PsA patients (88%) with at least one inflamed A1 pulley had a moderate/high disease activity score. The regression linear analysis (R2 = 0.36, adjusted R2 = 0.31) showed that A1 pulley inflammation was correlated with Disease Activity Index for Psoriatic Arthritis (DAPSA) (β = 0.43, p = 0.03).Conclusion: US A1 pulley inflammation appears to be relatively common at patient level in PsA, seems to be a characteristic feature of PsA compared to RA, and correlates with DAPSA.
Highlights
Finger flexor tendons and their surrounding synovial sheaths are located in osteofibrous channels, which are composed by the palmar aspect of the phalanges and metacarpal heads and by the digital fibrous tendon sheaths made by the digital pulleys [1]
In 2015, a magnetic resonance imaging (MRI) study turned the attention to the annular pulleys, demonstrating that these are common targets of inflammation in psoriatic arthritis (PsA) patients with dactylitis [5]
Two US studies evaluated the thickness of annular pulleys in chronic arthropathies, and both concluded that this is increased in PsA patients compared to rheumatoid arthritis (RA) patients and healthy subjects [6, 7]
Summary
Finger flexor tendons and their surrounding synovial sheaths are located in osteofibrous channels, which are composed by the palmar aspect of the phalanges and metacarpal heads and by the digital fibrous tendon sheaths made by the digital pulleys [1]. These structures are divided into annular pulleys (A1–A5) and cruciform pulleys, and their main function is to stabilize the tendons during finger flexion [1]. In 2015, a magnetic resonance imaging (MRI) study turned the attention to the annular pulleys, demonstrating that these are common targets of inflammation in psoriatic arthritis (PsA) patients with dactylitis [5]. In a very recent article, MRI signs of inflammatory involvement of annular pulleys were more often encountered in a small cohort of PsA patients compared to RA patients and healthy controls [10]
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