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![Types of dactylitis and corresponding presentation and findings [14]](publication/323188508/figure/tbl1/AS:873052913008643@1585163443332/Types-of-dactylitis-and-corresponding-presentation-and-findings-14.png)
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![Types of dactylitis and corresponding presentation and findings [14]](publication/323188508/figure/tbl1/AS:873052913008643@1585163443332/Types-of-dactylitis-and-corresponding-presentation-and-findings-14_Q320.jpg)
Objective
Dactylitis—long considered a hallmark clinical feature of psoriatic arthritis (PsA)—occurs in 16% to 49% of patients with PsA. In this review, we discuss the pathology of dactylitis in PsA and clinical and imaging tools used to diagnose and monitor dactylitis.
Methods
PubMed literature searches were conducted using the terms psoriatic ar...
Contexts in source publication
Context 1
... forms of dactylitis occur in patients with other types of SpA, particularly reactive arthritis [13,14]. However, dactylitis is not specific to SpA and can be present in patients with gout, syphilis, tuberculosis, flexor sheath infections, sickle cell disease, and sarcoidosis, although there are some differences between dactylitis in these conditions and dactylitis in SpA (Table 1; Fig. 2) [14,16]. Additionally, a less common form of sarcoid dactylitis, "drumstick dactylitis," can present as bulbous swelling of the distal finger or toe with nail involvement and can be differentiated from dactylitis in SpA by cutaneous symptoms such as lupus pernio [17]. ...Context 2
... infection with Mycobacterium marinum, has been reported to cause swelling consistent with dactylitis [16]. Because dactylitis may be the only feature of PsA for a considerable period of time [14], being able to differentiate PsA dactylitis from other forms is critical (Table 1). While dactylitis is clinically more overt than other features of PsA such as enthesitis, diagnosis may be difficult for the untrained eye, especially in patients with early or mild disease [54]. ...Context 3
... (radiography, US, MRI, and bone scintigraphy) plays a fundamental role in differentiating dactylitis from other causes of digit swelling (Table 1), monitoring disease progression and response to treatment, and-as previously discussed-dissecting the pathological bases for development of dactylitis. These modalities often reveal widespread abnormalities that are not observed clinically. ...Citations
... Dactylitis is seen in 16 to 49% of patients with juvenile psoriatic arthritis; recurrent dactylitis in the same digits may be the only symptom in initial years of the disease. 8 The diagnosis is often complicated by the fact that dactylitis is rather a common presentation of multiple digit diseases. Thus, in patients presenting with an isolated swollen digit, radiographs are essential to reach the correct diagnosis. ...
Rheumatic disorders in children include inflammatory arthritis, inflammatory bone disorders such as chronic nonbacterial osteomyelitis (CNO), connective tissue disorders, and vasculitides (juvenile dermatomyositis, scleroderma). The diagnosis in these children is based on a combination of history, clinical examination, and laboratory investigations. Radiographs play an important role in children with arthritis, who have atypical presentation or for assessment of disease-related damage and differentiation from mimics. Further, radiographs also have an ancillary role in the assessment of musculoskeletal disorders such as dermatomyositis and hemophilia. This review seeks to present a detailed analysis of the specific indications and advantages of radiographs in the situations. Further, a structured reporting format for assessment of radiographs in pediatric rheumatic disorders has also been presented for the reader's reference.
... Enthesitis and dactylitis are common periarticular manifestations and are considered the cardinal musculoskeletal lesions in early active psoriatic arthritis (PsA) [1][2][3]. The worldwide prevalence of enthesitis and dactylitis in patients with PsA ranges from 25% to 44% and 8% to 48%, respectively [4][5][6]. ...
The presence (vs absence) of enthesitis/dactylitis is associated with greater psoriatic arthritis (PsA) activity and reduced health-related quality of life. Risankizumab, an interleukin 23 antagonist, demonstrated superior treatment efficacy over placebo in patients with PsA, including enthesitis/dactylitis. Herein, we report the efficacy of risankizumab on complete resolution of enthesitis and/or dactylitis and improvements in patient-reported outcomes in patients with PsA.
This integrated post hoc analysis of data from KEEPsAKE 1 and KEEPsAKE 2 included patients with baseline enthesitis (Leeds Enthesitis Index > 0) and/or dactylitis (Leeds Dactylitis Index > 0). Efficacy outcomes at weeks 24 and 52 included proportion of patients achieving enthesitis and/or dactylitis resolution and minimal clinically important differences (MCID) in pain, Health Assessment Questionnaire-Disability Index, and Functional Assessment of Chronic Illness Therapy-Fatigue.
Of 1407 patients, approximately 63%, 28%, and 20% had baseline enthesitis, dactylitis, and both enthesitis/dactylitis, respectively. At week 24, higher response rates were observed for risankizumab vs placebo for resolution of enthesitis, dactylitis, and both enthesitis/dactylitis (differences of 13.9%, 16.9%, and 13.3%, respectively; p < 0.05). By week 52, risankizumab treatment resulted in complete resolution of enthesitis, dactylitis, and both enthesitis and dactylitis in 55.0%, 76.1%, and 52.3% of patients; similar resolution rates occurred among patients who switched from placebo to risankizumab. Among risankizumab-treated patients who achieved resolution of enthesitis and/or dactylitis, MCIDs were also attained in patient-reported pain, disability, and fatigue at week 24 (all p < 0.05; except fatigue in patients with resolution of both enthesitis/dactylitis); responses were sustained through week 52.
Higher proportions of risankizumab-treated (vs placebo-treated) patients achieved enthesitis and/or dactylitis resolution and meaningful improvements in patient-reported outcomes at week 24 and generally sustained responses at week 52. Thus, risankizumab may result in sustained alleviation of PsA-related pathognomonic musculoskeletal lesions of enthesitis/dactylitis.
NCT03675308, and NCT03671148.
... 2 3 The growing recognition of the importance of dactylitis is also evidenced by its increasing inclusion in clinical trials of targeted therapies for PsA. 4 High-resolution B-mode ultrasound offers a detailed anatomical imaging of the digital structures, and alongside Doppler ultrasound provides information on the inflammatory activity of digital soft tissues. On ultrasound, dactylitis consists of a variable combination of synovial and extrasynovial inflammatory lesions. ...
... The objectives of this OMERACT task force were the following: (1) to validate and characterise by histology the small entheses of the fingers identifiable by ultrasound and gross anatomy in finger specimens; (2) to select by international expert consensus the finger entheses suitable for ultrasound assessment and involved in PsA dactylitis; (3) to establish and define, based on data and experience, the ultrasound components of dactylitis, incorporating the previously selected entheses; (4) to develop an international consensus-based ultrasound scoring system for dactylitis in PsA, that is, Global OMERACT Ultrasound Dactylitis Score (GLOUDAS) and (5) to assess the intraobserver and interobserver reliability of the novel dactylitis scoring system. ...
Objectives
The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system.
Methods
The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis.
Results
32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39–0.71) and intraobserver reliability good to excellent (κ 0.80–0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes).
Conclusions
We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
... Psoriatic arthritis (PsA) is an inflammatory musculoskeletal and cutaneous disease with heterogenous clinical presentation and variable course. Musculoskeletal manifestations include enthesitis and dactylitis along with peripheral arthritis and axial disease often accompanied by the dermatologic manifestations of psoriasis and nail lesions [1][2][3]. These hallmark features of PsA should be considered separately in a disease domain-based approach to treatment [4,5]. ...
... Enthesitis is defined as inflammation of tendon, ligament, or joint capsule insertion sites to bone, while dactylitis is defined as diffuse Extended author information available on the last page of the article swelling of a digit resulting in sausage-shaped fingers or toes and constituted by inflammation of joints, extra-articular connective tissues, and bone in that digit [6,7]. These conditions occur variably in up to half of all patients with PsA (35-50% [enthesitis] and 16-50% [dactylitis]) [2,3,7]. Both enthesitis and dactylitis are associated with more severe disease and are often difficult to treat, thereby producing significant disease burden for PsA patients and challenges to clinicians treating patients with these manifestations [8,9]. ...
... These analyses were limited; they were largely post hoc in nature and patient cohorts with and without specific disease domains (especially enthesitis) were imbalanced in size. The presence of enthesitis and dactylitis was assessed using the LEI and DSS, rather than imaging techniques capable of capturing inflammatory changes [2,3], and the high prevalence of overweight and obese patients (72%) enrolled into these trials may have influenced the assessment of these features [7,42]. The LEI evaluates a limited number of anatomical sites (n = 6) with enthesitis, though results using this measure are concordant with other indices. ...
To evaluate the association between enthesitis resolution (ER) and dactylitis resolution (DR) and meaningful improvements in patient-reported outcomes (PROs) among biologic-naïve patients with PsA receiving guselkumab in the DISCOVER-2 study.
Enthesitis and dactylitis, characteristic lesions of PsA, were evaluated by independent assessors using the Leeds Enthesitis Index (range, 0–6) and Dactylitis Severity Score (range, 0–60). Proportions of patients with ER or DR (score = 0) among those with score > 0 at baseline were determined at weeks 24, 52, and 100. PROs included: fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue]), pain (0–100 visual analog scale), physical function (Health Assessment Questionnaire-Disability Index [HAQ-DI]), and health-related quality of life (36-item Short-Form Health Survey physical/mental component summary [SF-36 PCS/MCS]). Meaningful responses were defined as: improvements of ≥ 4 for FACIT-Fatigue, ≥ 0.35 for HAQ-DI, and ≥ 5 for SF-36 PCS/MCS and absolute scores of ≤ 15 for minimal pain and ≤ 0.5 for normalized HAQ-DI. Associations between ER/DR status and PRO response status were tested using a Chi-square test.
Guselkumab-treated patients with ER were more likely than those without ER to achieve minimal pain (p < 0.001), normalized HAQ-DI (p < 0.001), and PCS response (p < 0.05) at weeks 24, 52, and 100. Patients with DR were more likely than those without DR to achieve FACIT-Fatigue response at week 24 and week 52 (both p ≤ 0.01) and minimal pain at week 24 and normalized HAQ-DI at week 52 (both p ≤ 0.03).
In biologic-naïve patients with active PsA treated with guselkumab, achieving ER or DR was associated with durable improvements in selected PROs, including those of high importance to patients.
ClinicalTrials.gov (https://clinicaltrials.gov) NCT03158285; Registered: May 16, 2017.
Key Points
• At week 100, 65% and 76% of guselkumab-treated patients achieved enthesitis and dactylitis resolution (ER/DR).
• Achieving ER was associated with achieving DR and vice versa through the end of study.
• Achieving ER or DR was associated with durable and meaningful improvements in selected patient-reported outcomes.
... (1) En el caso específico de la espondilitis enteropática tiene como elemento común con las espondiloartropatías la afectación de la columna vertebral y de grandes articulaciones; el elemento distintivo está en la afectación del aparato digestivo en forma de colitis inflamatoria. (1,2) La expresión clínica de la enfermedad está sujeta directamente a la intensidad del proceso inflamatorio. ...
Introducción:
La espondilitis enteropática es una enfermedad inflamatoria, sistémica y crónica que se caracteriza por afectar el aparato digestivo y el sistema osteomioarticular; el proceso inflamatorio genera manifestaciones clínicas que afectan la capacidad funcional y la percepción de calidad de vida de los pacientes.
Objetivo:
Evaluar los resultados de una intervención nutricional orientada al control del proceso inflamatorio en pacientes con espondilitis enteropática.
Métodos:
Se realizó una investigación observacional y descriptiva longitudinal que incluyó como universo a 19 pacientes con diagnóstico confirmado de espondilitis enteropática atendidos en el Hospital Andino de Chimborazo en el periodo comprendido entre julio 2022 y julio 2023. La muestra quedó conformada por 17 pacientes. Se aplicó una intervención nutricional durante 10 meses que incluyó como elemento central la suplementación con alimentos ricos en probióticos según esquema definido por especialista en nutrición clínica.
Resultados:
Promedio de edad de 43,51 años, predominio del sexo femenino (64,70 %) y del tiempo de evolución de la enfermedad entre 5 y 10 años (58,82 %). Todos los marcadores de inflamación medidos durante el estudio mejoraron durante el seguimiento realizado a los pacientes; a los 9 meses se identificó aumento del porcentaje de pacientes con proteína C reactiva negativa y fibrinógeno y velocidad de sedimentación globular normal.
Conclusiones:
La intervención nutricional aplicada contribuye a mejorar los valores séricos de los marcadores de inflamación en los pacientes con diagnóstico de espondilitis enteropática.
... Dactylitis is a hallmark manifestation of psoriatic arthritis (PsA) that occurs in 16-49% of the reported cases (1,2). Clinically, it corresponds to a diffuse swelling of a digit of the hands or feet. ...
... Although its precise pathogenic mechanisms remain unknown, it can be considered as a pandigital inflammatory manifestation involving one or more tissue compartments: tenosynovitis, joint synovitis, enthesitis, soft-tissue and bone marrow oedema and erosive bone damage (1,(3)(4)(5). Dactylitis can present as two forms: acute and tender or chronic non-tender (1)(2)(3)5). The first is associated with increased disease activity, risk of joint damage and overall disease burden, whereas the chronic form might have less clinical impact (1,3). ...
... Dactylitis integrates the Classification Criteria for Psoriatic arthritis (CASPAR) and is a relevant outcome of PsA associated with local erosive structural damage (6,7). Despite the diversity of outcome measures used to assess dactylitis activity mainly in the context of clinical research, including clinical trials, the Leeds Dactylitis Index (LDI) is becoming widely accepted as a more objective measure for determining dactylitis activity in PsA (2,3,(8)(9)(10)(11)(12). The LDI is a validated instrument for assessing dactylitis that includes the measurement of the circumference of the digits, determined by a dactylometer, and the severity of pain upon palpation. ...
Objectives:
To estimate digit circumference and the impact of sex and body mass index (BMI) for the calculation of the Leeds Dactylitis Index (LDI) in psoriatic arthritis (PsA) patients with bilateral dactylitis.
Methods:
Digit circumference of the hands and the foot were measured with a dactylometer and were studied according to sex and BMI (divided in 4 weight categories) in healthy Portuguese subjects, using Student's t-test and One-way ANOVA, respectively. The effect size of sex and BMI were calculated using Cohen's d test and Eta squared, respectively. Multiple linear regression was used to calculate the effect of sex and BMI, as well as their interaction, to create a formula to predict digit circumference.
Results:
Fifty-nine participants (33 women, 26 men) with a mean BMI of 24.8 were included. Men's mean digit circumferences were statistically higher than those of women (p<0.001), with a large sex effect size in most of the digits. Differences in the mean circumference between the four BMI categories were statistically significant (p<0.05) for all digits, with a large BMI effect size. Sex and BMI were independent variables to predict mean digit circumference (p<0.001). A new tool (based on regression analysis) allowing to estimate the circumference of digits for males and females of different BMIs is presented.
Conclusions:
Our data allows the calculation of digit circumference for males and females of different BMIs in the Portuguese population; and shows that BMI influences digital circumference supporting BMI inclusion in LDI references tables.
... 20% of these patients may have destructive joint lesions. [2] Dactylitis is one of the presenting manifestations in patients with psoriatic variants of spondyloarthritis. Also known as a sausage-shaped digit, it can be seen in about 40% of psoriatic arthritis patients. ...
Background: Psoriatic arthritis was once diagnosed as Rheumatoid arthritis and was treated as such. Its significance as a separate arthritis has evolved after years of studies that revealed its pathogenesis, varied manifestations, and prognosis. It is one of the most common misdiagnosed inflammatory arthritis and requires its voice among the more known forms of arthritis. Material and Method: Cases coming to Rheumatology OPD with complaints of arthritis, dactylitis, and other associated presentations known in Psoriatic arthritis and its variants were collected. All the cases were extensively evaluated based on history, clinical findings, and investigations. Results: 6 cases were identified as having presentations of psoriatic arthritis. Patients came with manifestations like dactylitis, asymmetrical polyarthritis, oligoarthritis, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis), axial involvement and psoriatic osteoarthritis knee. Conclusion: This case series illuminates the importance of suspecting psoriatic arthritis in every case of arthritis showing the above-mentioned features as they may not have a classical history of psoriasis always. These patients are often treated with seronegative arthritis or early osteoarthritis. Correct assessment and treatment can improve the outcome in such patients as they may be responsive to different sets of medications and have different prognoses than Rheumatoid arthritis.
... Hypoechoic thickening of the tendon's insertional segment (Video 8) and/or of the periosteum, intracapsular bone proliferation, capsular hypertrophy, irregular bony surface at the tendon-bone junction (i.e., "ghost" bone), and vascular signals (Video 9) are the most common pathological findings [16,24,25]. The histological continuum between the tendon fibers and the periosteum is visible as a unique hypoechoic band wrapping the distal interphalangeal joint capsule and the cortex of the distal phalanx (Fig. 6) [26]. ...
... Lastly, nail abnormalities have also been described as additional sonographic findings concerning the distal entheseal anchorage network [24,27]. The more superficial fibers of the extensor tendon generate a superficial connective lamina that envelops/stabilizes the nail root. ...
... Likewise, local symptoms such as digital stiffness and pain also seem to be mainly related to the extracapsular inflammatory changes involving the superficial soft tissues, extra-articular vascular elements, and the tenosynovial tissue rather than the articular synovitis [3,30,31]. Kaeley et al. have defined the tenosynovial sheath swelling as the main pathological feature impairing finger flexion [24]. ...
The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis.
Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature.
Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected.
In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
... La dactilitis, o hinchazón circunferencial de los dedos, es un síntoma de la artritis reactiva y la psoriasis (17). Incluso en las primeras fases y como síntoma inicial de la enfermedad, la dactilitis está presente en el 16-49 % de los pacientes con artritis psoriásica (APs) (18). Los tofos, masas excéntricas alrededor de la articulación, son un signo de gota (Figura 1B) (14,16,19). ...
Resumen En este artículo se revisan los hallazgos de la radiografía convencional para distinguir entre patologías inflamatorias y degenerativas en pacientes con dolor articular. Al analizar una radiografía simple en el contexto de un dolor articular inflamatorio, es importante buscar signos clave de artropatía inflamatoria, como osteopenia yuxtaarticular, edema de partes blandas, calcificaciones, pérdida simétrica u homogénea del espacio articular y erosiones, así como hallazgos cardinales en función de la región anatómica evaluada, que ayuden a realizar un diagnóstico más preciso. La radiografía simple seguirá siendo una herramienta esencial para los médicos generalistas, internistas y reumatólogos a pesar de su baja sensibilidad y especificidad para las fases tempranas de las enfermedades. Palabras clave: artritis reumatoide, rayos X, reumatología, artropatía por depósitos de cristales, osteoartritis. Abstract This article reviews conventional radiography's findings for distinguishing inflammatory and degenerative pathologies in patients with joint pain. When analyzing a simple radiograph in the context of inflammatory joint pain, it is important to search for key signs of inflammatory arthropathy, such as juxta-articular osteopenia, soft tissue edema, calcifications, symmetric or homogeneous loss of joint space, and erosions, as well as cardinal findings depending on the anatomical region evaluated, which help make a more accurate diagnosis. Plain radiography will remain an essential tool for general practitioners, internists, and rheumatologists despite its low sensitivity and specificity for early pathologies.
... Both psoriasis and psoriatic arthritis may have disease flare-ups and remissions. However, dactylitis is not only related to SpA and can also affect those with gout, syphilis, TB, infections of the flexor sheath, sickle cell disease, and sarcoidosis (Kaeley et al. 2018). ...
Arthritis is derived from the Greek term “disease of the joints.” It is defined as an acute or
chronic joint inflammation that often co-exists with pain and structural damage. Hereditary and
acquired autoinflammatory illnesses have a direct correlation with several inflammasomes.
Numerous autoimmune illnesses, including systemic lupus erythematosus (SLE), type 1 and type
2 diabetes, neurological disorders, and cancer, have been linked to excessive inflammasome
activation. A frequent kind of systemic autoimmune illness that mostly affects synovial joints is
rheumatoid arthritis (RA). Osteoarthritis (OA) is the most common form of arthritis that
simultaneously affects the lives of elderly people as well as young individuals suffering posttraumatic
injuries. Any articular joint in the body may be affected by this chronic inflammatory disease, but knees, hands, feet, and fingers are most frequently affected. Compared to RA, OA
synovitis is more localized; in the knee, the suprapatellar pouch is the most prevalent location.
While synovitis may only play a small part in the development of OA in some people, it plays a
significant role in the destruction of joints in RA. Psoriasis is a multisystem, chronic
inflammatory skin illness that most frequently affects the extensor surfaces of the elbows and
knees. Blood and serological markers hold advantages over articular chemokines and radiology.
Since the autoantibodies can be identified in pre articular phase in blood. Rheumatoid arthritis is
allied with different autoantibodies including Rheumatoid factor (RF), Anti cyclic citrullinated
peptide antibody (ACPA), Anti keratin antibody (AKA), Anti perinuclear factor (APF) and Antifilaggrin
antibody. Conventional radiography (CR) is currently regarded as the gold standard
approach for evaluating structural damage. Radiography emphasizes the importance of cortical
bone, which is visible on standard X-rays due to its calcium concentration. Ultrasound is an
important tool in medical diagnostics. It is non-invasive and simple to perform, does not involve
radiation, and requires extremely portable equipment. PET is used in conjunction with a
structural imaging modality (most commonly CT) to generate detailed cross-sectional anatomical
pictures on which functional information can be placed. Several studies have already
demonstrated that PET can predict the onset of RA in patients without arthritis. Joint
scintigraphy is a non-invasive technique for detecting and measuring joint inflammation. Skeletal
scintigraphy is a more selective tool for detecting joint inflammation than radiography and is
more sensitive than clinical examination.
Keywords: Rheumatoid Arthritis, Rheumatoid Factor, Conventional radiography, Osteoarthritis
