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Symptomatic psoriatic dactylitis is associated with ultrasound determined extra-synovial inflammatory features and shorter disease duration

  • Nicolò Girolimetto
  • Luisa Costa
  • Luana Mancarella
  • Olga Addimanda
  • Paolo Bottiglieri
  • Francesco Santelli
  • Riccardo Meliconi
  • Rosario Peluso
  • Antonio Del Puente
  • Pierluigi Macchioni
  • Carlo Salvarani
  • Dennis McGonagle
  • Raffaele ScarpaEmail author
  • Francesco Caso
Original Article
  • 49 Downloads

Abstract

Objectives

To explore the link between ultrasonographic features of dactylitis in psoriatic arthritis (PsA) and symptoms, digital tenderness and duration of dactylitis.

Methods

Forty-eight cases of PsA dactylitis were investigated using high frequency ultrasound (US) both in grey scale (GS) and Power Doppler (PD), evaluating the presence and the degree of flexor tenosynovitis, peri-tendinous oedema, subcutaneous PD, extensor tendon involvement, GS synovitis and intra-articular PD signal (PDS) of the involved digits. Patients were compared according to the presence of local pain and digital tenderness, the duration of dactylitis and the concomitant treatment.

Results

The presence of pain/tenderness was positively associated with US GS flexor tenosynovitis of grade > 2 (p < 0.001), PD-flexor tenosynovitis (p < 0.001), peri-tendinous oedema (p < 0.001) and subcutaneous PDS (p < 0.001); moreover, it was negatively associated with GS synovitis (p < 0.001) and intra-articular PD (p < 0.001). The same positive and negative association with US findings were found comparing patients with duration of dactylitis shorter or longer than the median (24 weeks) (p < 0.001 for all comparisons).

Conclusions

Pain and digital tenderness are linked to dactylitis duration and earlier lesions are associated with extra synovial inflammatory changes. These findings suggest a hitherto unappreciated extra synovial basis for symptoms in PsA dactylitis.

Keywords

Dactylitis Digital tenderness Flexor Oedema Psoriatic arthritis Tenosynovitis Ultrasound 

Notes

Acknowledgments

The authors want to thank Professor Stefano Galletti for his suggestions.

Funding statement

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

The study was performed in accordance with the Helsinki Declaration of 1975, as amended in 2000, and the locally applicable laws. Written informed consent was taken from all subjects and the study protocol was approved by the local Ethics Committee.

Conflict of interest

DMG received grants and/or honoraria from Pfizer, MSD, Abbvie, BMS, UCB, Novartis, Celgene and Janssen.

The other authors have declared no conflicts of interest.

References

  1. 1.
    Gladman DD, Ziouzina O, Thavaneswaran A, Chandran V (2013) Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J Rheumatol 40:1357–1359CrossRefGoogle Scholar
  2. 2.
    Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C (2018) Dactylitis: a hallmark of psoriatic arthritis. Semin Arthritis Rheum 48:263–273.  https://doi.org/10.1016/j.semarthrit.2018.02.002 CrossRefPubMedGoogle Scholar
  3. 3.
    Brockbank JE, Stein M, Schentag CT, Gladman DD (2005) Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 64:188–190CrossRefGoogle Scholar
  4. 4.
    Caso F, Costa L, Atteno M, Del Puente A, Cantarini L, Lubrano E et al (2014) Simple clinical indicators for early psoriatic arthritis detection. Springerplus 3:759CrossRefGoogle Scholar
  5. 5.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European spondylarthropathy study group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227CrossRefGoogle Scholar
  6. 6.
    Peluso R, Costa L, Caso F, Del Puente A, Di Minno MN, Manguso F et al (2016) Dactylitis in enteropathic spondyloarthritis. Clin Exp Rheumatol 34:842–847PubMedGoogle Scholar
  7. 7.
    Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673CrossRefGoogle Scholar
  8. 8.
    Tillett W, Costa L, Jadon D, Wallis D, Cavill C, McHugh J et al (2012) The ClASsification for Psoriatic ARthritis (CASPAR) criteria - a retrospective feasibility, sensitivity, and specificity study. J Rheumatol 39:154–156CrossRefGoogle Scholar
  9. 9.
    Ramiro S, Smolen JS, Landewé R, van der Heijde D, Gossec L (2018) How are enthesitis, dactylitis and nail involvement measured and reported in recent clinical trials of psoriatic arthritis? A systematic literature review. Ann Rheum Dis 77:782–783CrossRefGoogle Scholar
  10. 10.
    Helliwell PS, Firth J, Ibrahim GH, Melsom RD, Shah I, Turner DE (2005) Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J Rheumatol 32:1745–1750PubMedGoogle Scholar
  11. 11.
    Healy PJ, Helliwell PS (2007) Measuring dactylitis in clinical trials: which is the best instrument to use? J Rheumatol 34:1302–1306PubMedGoogle Scholar
  12. 12.
    Eshed I, Bollow M, McGonagle DG, Tan AL, Althoff CE, Asbach P et al (2007) MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 66:1553–1559CrossRefGoogle Scholar
  13. 13.
    Bakewell CJ, Olivieri I, Aydin SZ, Dejaco C, Ikeda K, Gutierrez M, Terslev L, Thiele R, D'Agostino MA, Kaeley GS, OMERACT Ultrasound Task Force (2013) Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. J Rheumatol 40:1951–1957CrossRefGoogle Scholar
  14. 14.
    Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D (2015) High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 74:185–189CrossRefGoogle Scholar
  15. 15.
    Watad A, Eshed I, McGonagle D (2017) Lessons learned from imaging on enthesitis in psoriatic arthritis. Isr Med Assoc J 19:708–711 ReviewPubMedGoogle Scholar
  16. 16.
    Ferguson EG, Coates LC (2014) Optimisation of rheumatology indices: dactylitis and enthesitis in psoriatic arthritis. Clin Exp Rheumatol 32:113–117Google Scholar
  17. 17.
    Coates LC, Helliwell PS (2010) Disease measurement-enthesitis, skin, nails, spine and dactylitis. Best Pract Res Clin Rheumatol 24:659–670CrossRefGoogle Scholar
  18. 18.
    Möller I, Janta I, Backhaus M, Ohrndorf S, Bong DA, Martinoli C, Filippucci E, Sconfienza LM, Terslev L, Damjanov N, Hammer HB, Sudol-Szopinska I, Grassi W, Balint P, Bruyn GAW, D’Agostino MA, Hollander D, Siddle HJ, Supp G, Schmidt WA, Iagnocco A, Koski J, Kane D, Fodor D, Bruns A, Mandl P, Kaeley GS, Micu M, Ho C, Vlad V, Chávez-López M, Filippou G, Cerón CE, Nestorova R, Quintero M, Wakefield R, Carmona L, Naredo E (2017) The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 76:1974–1979CrossRefGoogle Scholar
  19. 19.
    Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B, Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649CrossRefGoogle Scholar
  20. 20.
    Naredo E, D'Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E, Iagnocco A, Karim Z, Terslev L, Bong DA, Garrido J, Martínez-Hernández D, Bruyn GAW, on behalf of the OMERACT Ultrasound Task Force* (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334CrossRefGoogle Scholar
  21. 21.
    Fournié B, Margarit-Coll N, Champetier de Ribes TL, Zabraniecki L, Jouan A, Vincent V, Chiavassa H, Sans N, Railhac JJ (2006) Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine 73:527–531CrossRefGoogle Scholar
  22. 22.
    Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W (2011) Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 70:1111–1114CrossRefGoogle Scholar
  23. 23.
    Wakefield RJ, O'Connor PJ, Conaghan PG, McGonagle D, Hensor EM, Gibbon WW et al (2007) Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging. Arthritis Rheum 57:1158–1164CrossRefGoogle Scholar
  24. 24.
    Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GAW, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D'Agostino MA, on behalf of the Outcome Measures in Rheumatology Ultrasound Task Force (2014) Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 66:741–748CrossRefGoogle Scholar
  25. 25.
    Filippou G, Di Sabatino V, Adinolfi A, Bertoldi I, Picerno V, Biasi G et al (2013) No enthesis should be overlooked when psoriatic arthritis is suspected: enthesitis of the extensor digitorum tendons. J Rheumatol 40:335CrossRefGoogle Scholar
  26. 26.
    Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487PubMedGoogle Scholar
  27. 27.
    Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48:955–962CrossRefGoogle Scholar
  28. 28.
    Olivieri I, Barozzi L, Favaro L, Pierro A, de Matteis M, Borghi C, Padula A, Ferri S, Pavlica P (1996) Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum 39:1524–1528CrossRefGoogle Scholar
  29. 29.
    Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O (1999) Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 26:1746–1751PubMedGoogle Scholar
  30. 30.
    Wakefield RJ, Emery P, Veale D (2000) Ultrasonography and psoriatic arthritis. J Rheumatol 27:1564–1565PubMedGoogle Scholar
  31. 31.
    Giovagnoni A, Grassi W, Terilli F, Blasetti P, Paci E, Ercolani P et al (1995) MRI of the hand in psoriatic and rheumatical arthritis. Eur Radiol 5:590–595CrossRefGoogle Scholar
  32. 32.
    Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O (1995) Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skelet Radiol 24:351–355CrossRefGoogle Scholar
  33. 33.
    Olivieri I, Scarano E, Padula A, D'Angelo S, Salvarani C, Cantini F et al (2008) Fast spin echo-T2-weighted sequences with fat saturation in toe dactylitis of spondyloarthritis. Clin Rheumatol 27:1141–1145CrossRefGoogle Scholar
  34. 34.
    Healy PJ, Groves C, Chandramohan M, Helliwell PS (2008) MRI changes in psoriatic dactylitis-extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology (Oxford) 47:92–95CrossRefGoogle Scholar
  35. 35.
    Tinazzi I, McGonagle D, Zabotti A, Chessa D, Marchetta A, Macchioni P (2018) Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin Exp Rheumatol 36(5):785–790PubMedGoogle Scholar
  36. 36.
    Pereira DF, Gutierrez M, de Buosi AL, Ferreira FB, Draghessi A, Grassi W et al (2015) Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings? Clin Rheumatol 34:1975–1979CrossRefGoogle Scholar
  37. 37.
    Hirata A, Ogura T, Hayashi N, Takenaka S, Ito H, Mizushina K, Fujisawa Y, Yamashita N, Nakahashi S, Imamura M, Kujime R, Kameda H (2017) Concordance of patient-reported joint symptoms, physician-examined arthritic signs, and ultrasound-detected synovitis in rheumatoid arthritis. Arthritis Care Res 69:801–806CrossRefGoogle Scholar
  38. 38.
    Dejaco C, Stadlmayr A, Duftner C, Trimmel V, Husic R, Krones E, Zandieh S, Husar-Memmer E, Zollner G, Hermann J, Gretler J, Lackner A, Ficjan A, Datz C, Axman R, Zwerina J (2017) Ultrasound verified inflammation and structural damage in patients with hereditary haemochromatosis-related arthropathy. Arthritis Res Ther 19:243CrossRefGoogle Scholar
  39. 39.
    McGonagle D, Gibbon W, Emery P (1998) Classification of inflammatory arthritis by enthesitis. Lancet 352:1137–1140CrossRefGoogle Scholar
  40. 40.
    McGonagle D, Gibbon W, O'Connor P, Green M, Pease C, Emery P (1998) Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 41:694–700CrossRefGoogle Scholar
  41. 41.
    McGonagle D, Lories RJ, Tan AL, Benjamin M (2007) The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 56:2482–2491CrossRefGoogle Scholar
  42. 42.
    Tan AL, Tanner SF, Waller ML, Hensor EM, Burns A, Jeavons AP et al (2013) High-resolution [18F]fluoride positron emission tomography of the distal interphalangeal joint in psoriatic arthritis--a bone-enthesis-nail complex. Rheumatology (Oxford) 52:898–904CrossRefGoogle Scholar
  43. 43.
    Lories RJ, Matthys P, de Vlam K, Derese I, Luyten FP (2004) Ankylosing enthesitis, dactylitis, and onychoperiostitis in male DBA/1 mice: a model of psoriatic arthritis. Ann Rheum Dis 63:595–598CrossRefGoogle Scholar
  44. 44.
    Mathew AJ, Bird P, Gupta A, George R, Danda D (2018) Magnetic resonance imaging (MRI) of feet demonstrates subclinical inflammatory joint disease in cutaneous psoriasis patients without clinical arthritis. Clin Rheumatol 37:383–388CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Nicolò Girolimetto
    • 1
  • Luisa Costa
    • 1
  • Luana Mancarella
    • 2
  • Olga Addimanda
    • 2
    • 3
  • Paolo Bottiglieri
    • 1
  • Francesco Santelli
    • 4
  • Riccardo Meliconi
    • 2
    • 3
  • Rosario Peluso
    • 1
  • Antonio Del Puente
    • 1
  • Pierluigi Macchioni
    • 5
  • Carlo Salvarani
    • 5
    • 6
  • Dennis McGonagle
    • 7
  • Raffaele Scarpa
    • 1
    Email author return OK on get
  • Francesco Caso
    • 1
  1. 1.Department of Clinical and Experimental Medicine, Rheumatology Research UnitUniversity Federico IINaplesItaly
  2. 2.Medicine & Rheumatology UnitRizzoli Orthopaedic InstituteBolognaItaly
  3. 3.Department of Biomedical & Neuromotor SciencesUniversity of BolognaBolognaItaly
  4. 4.Department of Social SciencesUniversity Federico IINaplesItaly
  5. 5.Department of RheumatologyAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
  6. 6.Rheumatology UnitUniversity of Modena and Reggio EmiliaModenaItaly
  7. 7.NIHR Leeds Musculoskeletal Biomedical Research CentreLeeds Teaching Hospitals Trust and the University of LeedsLeedsUK

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