Abstract
Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the articular synovium; the small enthesis of the hands. Dactylitis is currently considered both a marker of disease activity and severe prognosis and its importance in PsA is emphasized by the inclusion in the classification criteria of PsA. This review focuses on the role of imaging in the management of PsA patients with dactylitis in clinical practice and in a research setting. Furthermore, imaging could be a valuable tool to assist in unravelling some of the underlying mechanisms of the onset and chronicization of dactylitis in PsA patients.
Highlights
Recent cross-sectional US studies involving only hand dactylitis reported a prevalence of flexor tenosynovitis ranging from 83 to 94% in grey scale (GS) and from 69 to 78% in power Doppler (PD) modes [8,9,38,39]
A subsequent study reported similar results in a larger series that included 100 affected fingers; Figure 3 reported the prevalence of flexor tenosynovitis, soft-tissue oedema (STOe) and synovitis after splitting cases into quartiles based on dactylitis duration [39]. These findings demonstrated that flexor tenosynovitis and soft tissue oedema are predominant in early cases, whereas synovitis is more frequent in the chronic form (Figure 2)
The article: Girolimetto et al J Rheumatol
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Psoriatic arthritis (PsA) is the most common disease that causes dactylitis due to joint, tendon, and soft tissue inflammation. Called “cold” dactylitis, presents as a non-tender, swollen finger. It is unknown whether a lack of tenderness represents the resolution of an acute dactylitis or suggests inactive disease [7]. The mostAcute/tender frequently dactylitis, is characterized by a slightly reddish, tender, and swollen digit. Recent studies that thethat absence of tenderness might and the association with the handsuggest may indicate trauma or injury might be explained the anatomical compartmentalization of dactylitic-related sonographic play a role in by triggering the disease [10], supporting the deep Koebner phenomenon abnormalities theory [11]. Joints [15,16]
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