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



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


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.


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).


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.


Dactylitis Digital tenderness Flexor Oedema Psoriatic arthritis Tenosynovitis Ultrasound 



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.


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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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