Abstract
Objective
Despite diffuse digital swelling, dactylitis may sometimes be asymptomatic. The objective of this study was to compare the clinical and ultrasonographic features of symptomatic with asymptomatic psoriatic arthritis (PsA) dactylitis.
Methods
One hundred and twenty-five hand dactylitis were evaluated in a multicenter cross-sectional study for the presence of pain, subjective functional limitation, and tenderness (4-points scale) with the calculation of a Leeds Dactylitis Index (LDI) score. Fingers were subsequently investigated using high-frequency ultrasound (US) both in gray-scale (GS) and power Doppler (PD), for the presence and grading of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDUS), extensor tendon involvement, and joints synovitis. Clinical and US characteristics of symptomatic dactylitic fingers were compared with the asymptomatic dactylitic ones.
Results
Symptomatic fingers (n = 80) had a significantly lower dactylitis duration compared to asymptomatic fingers (n = 36) (p < 0.001). Values of LDI, patient VAS-pain, and VAS-functional score were significantly higher in fingers with symptomatic dactylitis (p < 0.001 and p = 0.010, respectively). Symptomatic dactylitis had a higher prevalence of flexor tenosynovitis of grade > 2, soft tissue edema and subcutaneous PDUS signal (p < 0.001). Asymptomatic dactylitis showed a greater prevalence of joint synovitis (both in GS and in PD) than symptomatic dactylitis (p < 0.001).
Conclusions
Digital tenderness and pain are linked to US tenosynovitis of grade > 2 and extra synovial abnormalities and conversely asymptomatic dactylitis is associated with joint-based synovitis.
Key Points • Digital tenderness and local pain in psoriatic arthritis dactylitis are strongly associated with flexor tenosynovitis of grade> 2, soft tissue edema, and subcutaneous PD signal. • In psoriatic arthritis, asymptomatic dactylitis showed a greater prevalence of joint synovitis than symptomatic dactylitis. • In psoriatic arthritis, ultrasound inflammatory abnormalities are present in about 70% of cold dactylitis which is linked for disease chronicity. • In psoriatic arthritis, the flexor tendon and adjacent soft tissues play a significant role in symptomatic dactylitis. |
Similar content being viewed by others
References
Gladman DD, Ziouzina O, Thavaneswaran A, Chandran V (2013) Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J Rheumatol 40:1357–1359
Gladman DD, Chandran V (2011) Observational color studies: lessons learnt from the University of Toronto Psoriatic Arthritis Program. Rheumatology (Oxford) 50:25–31
Caso F, Costa L, Atteno M, Del Puente A, Cantarini L, Lubrano E, Scarpa R (2014) Simple clinical indicators for early psoriatic arthritis detection. Springerplus 22(3):759
Olivieri I, Scarano E, Padula A, Giasi V (2003) Dactylitis involving most of the fingers. Clin Exp Rheumatol 21:406
Brockbank JE, Stein M, Schentag CT, Gladman DD (2005) Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 64:188–190
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 54:2665–2673
Tillett W, Costa L, Jadon D, Wallis D, Cavill C, McHugh J, Korendowych E, McHugh N (2012) The ClASsification for Psoriatic ARthritis (CASPAR) criteria - a retrospective feasibility, sensitivity, and specificity study. J Rheumatol 39:154–156
Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227
Peluso R, Costa L, Caso F, Del Puente A, Di Minno MN, Manguso F, Castiglione F, Scarpa R (2016) Dactylitis in enteropathic spondyloarthritis. Clin Exp Rheumatol 34:842–847
Gladman DD (2015) Clinical features and diagnostic considerations in psoriatic arthritis. Rheum Dis Clin N Am 41:569–579
Gladman DD, Helliwell P, Mease PJ, Nash P, Ritchlin C, Taylor W (2004) Assessment of patients with psoriatic arthritis: a review of currently available measures. Arthritis Rheum 50:24–35
Coates LC, Helliwell PS (2010) Disease measurement-enthesitis, skin, nails, spine and dactylitis. Best Pract Res Clin Rheumatol 24:659–670
Ferguson EG, Coates LC (2014) Optimisation of rheumatology indices: dactylitis and enthesitis in psoriatic arthritis. Clin Exp Rheumatol 32:113–117
Wright V, Moll JM (1971) Psoriatic arthritis. Bull Rheum Dis 21:627–632
Scarpa R, Caso F, Costa L, Peluso R, Del Puente A, Olivieri I (2017) Psoriatic disease 10 years later. J Rheumatol 44:1298–1301
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 39:1524–1528
Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O (1999) Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 26:1746–1751
Wakefield RJ, Emery P, Veale D (2000) Ultrasonography and psoriatic arthritis. J Rheumatol 27:1564–1565
Olivieri I, Barozzi L, Pierro A, De Matteis M, Padula A, Pavlica P (1997) Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging. J Rheumatol 24:926–930
Olivieri I, Scarano E, Padula A, D'Angelo S, Salvarani C, Cantini F, Niccoli L, Barozzi L (2008) Fast spin echo-T2-weighted sequences with fat saturation in toe dactylitis of spondyloarthritis. Clin Rheumatol 27:1141–1145
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) 47:92–95
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 73:527–531
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 36:785–790
Girolimetto N, Costa L, Mancarella L, Addimanda O, Bottiglieri P, Santelli F, Meliconi R, Peluso R, Del Puente A, Macchioni P, Salvarani C, McGonagle D, Scarpa R, Caso F (2019) Symptomatic psoriatic dactylitis is associated with ultrasound determined extra-synovial inflammatory features and shorter disease duration. Clin Rheumatol 38:903–911
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 32:1745–1750
Yamamoto T (2015) Optimal management of dactylitis in patients with psoriatic arthritis. Open Access Rheumatol 7:55–62
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 76:1974–1979
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 GA, OMERACT Ultrasound Task Force (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334
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 70:1111–1114
Wakefield RJ, O'Connor PJ, Conaghan PG, McGonagle D, Hensor EM, Gibbon WW, Brown C, Emery P (2007) Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging. Arthritis Rheum 57:1158–1164
Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GA, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D’Agostino MA, 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) 66:741–748
Filippou G, Di Sabatino V, Adinolfi A, Bertoldi I, Picerno V, Biasi G, Galeazzi M, Frediani B (2013) No enthesis should be overlooked when psoriatic arthritis is suspected: enthesitis of the extensor digitorum tendons. J Rheumatol 40:335
Terslev L, Naredo E, Aegerter P, Wakefield RJ, Backhaus M, Balint P, Bruyn GAW, Iagnocco A, Jousse-Joulin S, Schmidt WA, Szkudlarek M, Conaghan PG, Filippucci E, D’Agostino MA (2017) Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open 3:e000427
D'Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, Filippucci E, Grassi W, Iagnocco A, Jousse-Joulin S, Kane D, Naredo E, Schmidt W, Szkudlarek M, Conaghan PG, Wakefield RJ (2017) Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 3:e000428
Girolimetto N, Macchioni P, Tinazzi I, Costa L, McGonagle D, Peluso R, Del Puente A, Addimanda O, Marchetta A, Possemato N, Tasso M, Salvarani C, Scarpa R, Caso F (2019) Ultrasonographic evidence of predominance of acute extracapsular and chronic intrasynovial patterns in 100 psoriatic hand dactylitis. J Rheumatol:jrheum.190046. https://doi.org/10.3899/jrheum.190046
McGonagle D, Tan AL, Watad A, Helliwell P (2019) Pathophysiology, assessment and treatment of psoriatic dactylitis. Nat Rev Rheumatol 15:113–122
Padula A, Salvarani C, Barozzi L, De Matteis M, Pavlica P, Cantini F, Olivieri I (1998) Dactylitis also involving the synovial sheaths in the palm of the hand: two more cases studied by magnetic resonance imaging. Ann Rheum Dis 57:61–62
Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773
Yoshimi R, Hama M, Takase K, Ihata A, Kishimoto D, Terauchi K, Watanabe R, Uehara T, Samukawa S, Ueda A, Takeno M, Ishigatsubo Y (2013) Ultrasonography is a potent tool for the prediction of progressive joint destruction during clinical remission of rheumatoid arthritis. Mod Rheumatol 23:456–465
Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A (2014) Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford) 53:2110–2118
Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S, Bourgeois P, Fautrel B (2012) Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum 64:67–76
Geijer M, Lindqvist U, Husmark T, Alenius GM, Larsson PT, Teleman A, Theander E (2015) The Swedish early psoriatic arthritis registry 5-year follow up: substantial radiographic progression mainly in men with high disease activity and development of dactylitis. J Rheumatol 42:2110–2117
Pereira DF, Gutierrez M, de Buosi AL, Ferreira FB, Draghessi A, Grassi W, Natour J, Furtado RN (2015) Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings? Clin Rheumatol 34:1975–1979
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 69:801–806
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 19:243
Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EM, Wakefield RJ, Emery P, Helliwell PS, Conaghan PG (2014) Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res 66:432–439
Delle Sedie A, Riente L, Filippucci E, Scirè CA, Iagnocco A, Meenagh G, Gutierrez M, Valesini G, Montecucco C, Grassi W, Bombardieri S (2011) Ultrasound imaging for the rheumatologist. XXXII Sonographic assessment of the foot in patients with psoriatic arthritis. Clin Exp Rheumatol 29:217–222
Emad Y, Ragab Y, Gheita T, Anbar A, Kamal H, Saad A, Darweesh H, El-Shaarawy N, Azab A, Ismail A, Rasker JJ, Knee Enthesitis Working Group (2012) Knee enthesitis and synovitis on magnetic resonance imaging in patients with psoriasis without arthritic symptoms. J Rheumatol 39:1979–1986
Elnady B, El Shaarawy NK, Dawoud NM, Elkhouly T, Desouky DE, ElShafey EN, El Husseiny MS, Rasker JJ (2019) Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two years. Clin Rheumatol 38:1627–1635. https://doi.org/10.1007/s10067-019-04445-0
McGonagle D, Gibbon W, Emery P (1998) Classification of inflammatory arthritis by enthesitis. Lancet 3:1137–1140
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 41:694–700
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 56:2482–2491
Tan AL, Tanner SF, Waller ML, Hensor EM, Burns A, Jeavons AP, Bury RF, Emery P, McGonagle D (2013) High-resolution [18F]fluoride positron emission tomography of the distal interphalangeal joint in psoriatic arthritis--a bone-enthesis-nail complex. Rheumatology (Oxford) 52:898–904
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 63:595–598
Ostergaard M, McQueen F, Wiell C, Bird P, Bøyesen P, Ejbjerg B, Peterfy C, Gandjbakhch F, Duer-Jensen A, Coates L, Haavardsholm EA, Hermann KG, Lassere M, O'Connor P, Emery P, Genant H, Conaghan PG (2009) The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA hands. J Rheumatol 36:1816–1824
Bøyesen P, McQueen FM, Gandjbakhch F, Lillegraven S, Coates L, Wiell C, Haavardsholm EA, Conaghan PG, Peterfy CG, Bird P, Ostergaard M (2011) The OMERACT psoriatic arthritis magnetic resonance imaging score (PsAMRIS) is reliable and sensitive to change: results from an OMERACT workshop. J Rheumatol 38:2034–2038
McQueen F, Lassere M, Bird P, Haavardsholm EA, Peterfy C, Conaghan PG, Ejbjerg B, Genant H, O'Connor P, Emery P, Østergaard M (2007) Developing a magnetic resonance imaging scoring system for peripheral psoriatic arthritis. J Rheumatol 34:859–861
Mancarella L, Addimanda O, Pelotti P, Pignotti E, Pulsatelli L, Meliconi R (2015) Ultrasound detected inflammation is associated with the development of new bone erosions in hand osteoarthritis: a longitudinal study over 3.9 years. Osteoarthr Cartil 23:1925–1932
Mancarella L, Addimanda O, Cavallari C, Meliconi R (2017) Synovial inflammation drives structural damage in hand osteoarthritis: a narrative literature. Curr Rheumatol Rev 13:43–50
Okano T, Mamoto K, Di Carlo M, Salaffi F (2019) Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med. https://doi.org/10.1007/s11547-019-01013-z
Hayashi D, Roemer FW, Guermazi A (2018) Recent advances in research imaging of osteoarthritis with focus on MRI, ultrasound and hybrid imaging. Clin Exp Rheumatol 36:43–52
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Ethical approval
The study was approved by the local ethical Committee of the University Federico II, Naples, Italy (number approval 5/12), and was conducted in conformity with The Declaration of Helsinki and its later amendments. A written informed consent was obtained from all participants.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 18 kb)
Rights and permissions
About this article
Cite this article
Girolimetto, N., Macchioni, P., Tinazzi, I. et al. Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. Clin Rheumatol 39, 1157–1165 (2020). https://doi.org/10.1007/s10067-019-04683-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-019-04683-2