Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis

results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis

Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Luisa Costa, Rosario Peluso, Marco Tasso, Vittoria Bascherini, Olga Addimanda, Antonio Marchetta, Niccolò Possemato, Carlo Salvarani, Dennis McGonagle, Raffaele Scarpa, Francesco Caso

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalClinical Rheumatology
DOIs
Publication statusPublished - Jan 1 2019

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Psoriatic Arthritis
Hand
Cross-Sectional Studies
Fingers
Synovitis
Subcutaneous Tissue
Tenosynovitis
Edema
Joints
Tendons
Pain
Power (Psychology)

Keywords

  • Cold dactylitis
  • Dactylitis
  • Flexor tendon
  • Psoriatic arthritis
  • Symptoms
  • Tenderness
  • Tenosynovitis
  • Ultrasonography

ASJC Scopus subject areas

  • Rheumatology

Cite this

Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis : results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. / Girolimetto, Nicolò; Macchioni, Pierluigi; Tinazzi, Ilaria; Costa, Luisa; Peluso, Rosario; Tasso, Marco; Bascherini, Vittoria; Addimanda, Olga; Marchetta, Antonio; Possemato, Niccolò; Salvarani, Carlo; McGonagle, Dennis; Scarpa, Raffaele; Caso, Francesco.

In: Clinical Rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

Girolimetto, Nicolò ; Macchioni, Pierluigi ; Tinazzi, Ilaria ; Costa, Luisa ; Peluso, Rosario ; Tasso, Marco ; Bascherini, Vittoria ; Addimanda, Olga ; Marchetta, Antonio ; Possemato, Niccolò ; Salvarani, Carlo ; McGonagle, Dennis ; Scarpa, Raffaele ; Caso, Francesco. / Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis : results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. In: Clinical Rheumatology. 2019.
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title = "Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis",
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.",
keywords = "Cold dactylitis, Dactylitis, Flexor tendon, Psoriatic arthritis, Symptoms, Tenderness, Tenosynovitis, Ultrasonography",
author = "Nicol{\`o} Girolimetto and Pierluigi Macchioni and Ilaria Tinazzi and Luisa Costa and Rosario Peluso and Marco Tasso and Vittoria Bascherini and Olga Addimanda and Antonio Marchetta and Niccol{\`o} Possemato and Carlo Salvarani and Dennis McGonagle and Raffaele Scarpa and Francesco Caso",
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T1 - Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis

T2 - results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis

AU - Girolimetto, Nicolò

AU - Macchioni, Pierluigi

AU - Tinazzi, Ilaria

AU - Costa, Luisa

AU - Peluso, Rosario

AU - Tasso, Marco

AU - Bascherini, Vittoria

AU - Addimanda, Olga

AU - Marchetta, Antonio

AU - Possemato, Niccolò

AU - Salvarani, Carlo

AU - McGonagle, Dennis

AU - Scarpa, Raffaele

AU - Caso, Francesco

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cold dactylitis

KW - Dactylitis

KW - Flexor tendon

KW - Psoriatic arthritis

KW - Symptoms

KW - Tenderness

KW - Tenosynovitis

KW - Ultrasonography

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