Isolated peripheral enthesitis and/or dactylitis: A subset of psoriatic arthritis

Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Pierluigi Macchioni, Laura Niccoli, Angela Padula, Silvio Ferri, Italo Portioli

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Objective. To identify isolated peripheral enthesitis and/or dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients. Methods. We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group. Results. 14 patients (3.5%) presented isolated episodes of peripheral enthesitis and/or dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71%) presented at least one episode of finger and/or toe dactylitis. 5 of these 10 patients (50%) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57%). 3 of these 8 patients (37%) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4%) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of dactylitis. The frequency of isolated Achilles tendinitis and/or dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2%; p = 0.001). Conclusion. In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA.

Original languageEnglish
Pages (from-to)1106-1110
Number of pages5
JournalJournal of Rheumatology
Volume24
Issue number6
Publication statusPublished - Jun 1997

Fingerprint

Psoriatic Arthritis
Tendinopathy
Plantar Fasciitis
Spondylarthropathies
Toes
Spondylarthritis
Sacroiliitis
HLA-B27 Antigen
Patellar Ligament
Control Groups
Patella
Thigh
Psoriasis

Keywords

  • Dactylitis
  • Peripheral enthesitis
  • Psoriatic arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Salvarani, C., Cantini, F., Olivieri, I., Macchioni, P., Niccoli, L., Padula, A., ... Portioli, I. (1997). Isolated peripheral enthesitis and/or dactylitis: A subset of psoriatic arthritis. Journal of Rheumatology, 24(6), 1106-1110.

Isolated peripheral enthesitis and/or dactylitis : A subset of psoriatic arthritis. / Salvarani, Carlo; Cantini, Fabrizio; Olivieri, Ignazio; Macchioni, Pierluigi; Niccoli, Laura; Padula, Angela; Ferri, Silvio; Portioli, Italo.

In: Journal of Rheumatology, Vol. 24, No. 6, 06.1997, p. 1106-1110.

Research output: Contribution to journalArticle

Salvarani, C, Cantini, F, Olivieri, I, Macchioni, P, Niccoli, L, Padula, A, Ferri, S & Portioli, I 1997, 'Isolated peripheral enthesitis and/or dactylitis: A subset of psoriatic arthritis', Journal of Rheumatology, vol. 24, no. 6, pp. 1106-1110.
Salvarani C, Cantini F, Olivieri I, Macchioni P, Niccoli L, Padula A et al. Isolated peripheral enthesitis and/or dactylitis: A subset of psoriatic arthritis. Journal of Rheumatology. 1997 Jun;24(6):1106-1110.
Salvarani, Carlo ; Cantini, Fabrizio ; Olivieri, Ignazio ; Macchioni, Pierluigi ; Niccoli, Laura ; Padula, Angela ; Ferri, Silvio ; Portioli, Italo. / Isolated peripheral enthesitis and/or dactylitis : A subset of psoriatic arthritis. In: Journal of Rheumatology. 1997 ; Vol. 24, No. 6. pp. 1106-1110.
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abstract = "Objective. To identify isolated peripheral enthesitis and/or dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients. Methods. We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group. Results. 14 patients (3.5{\%}) presented isolated episodes of peripheral enthesitis and/or dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71{\%}) presented at least one episode of finger and/or toe dactylitis. 5 of these 10 patients (50{\%}) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57{\%}). 3 of these 8 patients (37{\%}) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4{\%}) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of dactylitis. The frequency of isolated Achilles tendinitis and/or dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2{\%}; p = 0.001). Conclusion. In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA.",
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