Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis

Dubash, Sayam; Alabas, Oras; Michelena, Xabier; Garcia-Montoya, Leticia; Wakefield, Richard J.; Helliwell, Philip S.; Emery, Paul; McGonagle, Dennis; Tan, Ai Lyn; Marzo‐Ortega, Helena

doi:10.1136/annrheumdis-2021-220964

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…However, for PsA, a definition of severity is still lacking; in 2005, Brockbanck et al proposed dactylitis as a clinical marker of disease severity because of its association with a greater degree of radiological damage [ 19 ]. This concept is in keeping with a recent study in which early PsA patients (DMARDs-naïve) with dactylitis seem to have a greater burden of disease (greater SwJC, TJC, CRP, ultrasound synovitis and erosive damage) [ 20 ] when compared to early PsA patients without dactylitis. Therefore, it could be supposed that EOP is also a marker of severity in PsO, due to the association that we found between EOP and dactylitis.…”

Section: Discussionsupporting

confidence: 80%

Dactylitis and Early Onset Psoriasis in Psoriatic Arthritis: Are they Markers of Disease Severity? A Clinical Study

et al. 2022

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Objectives To stratify psoriatic arthritis (PsA) patients based on psoriasis (PsO) onset age: early onset psoriasis (EOP) vs. late onset psoriasis (LOP), and to assess if there are differences in disease characteristics, activity/function/impact of the disease, and comorbidity indices. Methods Cross-sectional analysis of a longitudinal PsA cohort. Patients were stratified based on PsO onset age. Results One hundred and sixty PsA patients were enrolled (84 in EOP and 76 in LOP group) in the study. EOP PsA patients seem to have an increased probability to have dactylitis rather than LOP ones, OR 9.64 (3.77–24.6). Comorbidity indices (Rheumatic Disease Comorbidity Index and Charlson Comorbidity Index) were higher in LOP PsA patients, but these data were not confirmed when adjusted by age and sex. There are also differences in the treatment regimen: EOP PsA patients were more frequently treated with anti-interleukin (IL) 17; instead, LOP patients were more frequently treated with non-steroid anti-inflammatory drugs and conventional synthetic disease-modifying anti-rheumatics drugs. There were no differences in the disease activity, function, or impact of the disease. Conclusions There are some clinical and therapeutic differences in PsA patients linked to the PsO onset age, namely dactylitis in EOP. Other characteristics found were: a “comorbidities trend” in LOP patients and a more frequent use of anti-IL17 in EOP. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00468-3.

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Section: Discussionsupporting

confidence: 80%

Dactylitis and Early Onset Psoriasis in Psoriatic Arthritis: Are they Markers of Disease Severity? A Clinical Study

et al. 2022

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“…Dactylitis, a characteristic feature of PsA, is one of six clinical domains considered in PsA treatment decisions, along with peripheral arthritis, axial disease, enthesitis, skin disease, and nail disease ( 2 ). Dactylitis typically presents as swelling of the whole digit, with inflammation in the joints, soft tissues, and tendon sheaths ( 3 , 4 , 5 , 6 ). Although dactylitis can occur in patients with other diseases, it is a hallmark feature of PsA, developing in up to 50% of patients at some point during their disease course, with toes affected more often than fingers ( 5 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Dactylitis typically presents as swelling of the whole digit, with inflammation in the joints, soft tissues, and tendon sheaths ( 3 , 4 , 5 , 6 ). Although dactylitis can occur in patients with other diseases, it is a hallmark feature of PsA, developing in up to 50% of patients at some point during their disease course, with toes affected more often than fingers ( 5 , 6 , 7 ). Imaging studies in patients with PsA revealed that flexor tenosynovitis with diffuse extra‐tendinous inflammation with an epicenter around accessory pulleys is a characteristic feature of dactylitis pathogenesis, helping to differentiate it from rheumatoid and other forms of arthritis ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…PsA treatments that provide high levels of dactylitis improvement and resolution are important because dactylitis is a clinical marker for a more severe disease phenotype in patients with early PsA, characterized by higher swollen joint count (SJC), higher C‐reactive protein (CRP) levels, and more synovitis and bone erosions on imaging ( 5 ). In patients with chronic PsA, dactylitis is associated with a higher degree of radiographic damage ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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Guselkumab, a Selective Interleukin‐23 p19 Subunit Inhibitor, Resolves Dactylitis in Patients With Active Psoriatic Arthritis: Pooled Results Through Week 52 From Two Phase 3 Studies

McGonagle

McInnes

Deodhar

et al. 2023

ACR Open Rheumatology

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Objective Previous analyses of pooled DISCOVER‐1 and DISCOVER‐2 data through Week 24 showed significantly higher rates of dactylitis resolution in patients treated with guselkumab compared with placebo. Here, we investigate associations between dactylitis resolution and other outcomes through 1 year. Methods Patients were randomized 1:1:1 to receive subcutaneous injections of guselkumab 100 mg at Week 0, Week 4, and then every 4 or 8 weeks, or placebo with crossover to guselkumab at Week 24. Independent assessors determined dactylitis severity score (DSS; 0‐3/digit; total = 0‐60). Dactylitis resolution (DSS = 0) (prespecified) and at least 20%, at least 50%, and at least 70% DSS improvement from baseline (post hoc) were determined through Week 52 (nonresponder imputation for treatment failure through Week 24 and for missing data through Week 52). ACR50, tender/swollen joints, low disease activity (LDA) as assessed by composite indices, and radiographic progression (DISCOVER‐2 only) were assessed in patients with dactylitis versus without dactylitis resolution at Week 24 and Week 52. Results Patients with dactylitis at baseline (473 of 1118) had more severe joint and skin disease than those without dactylitis (645 of 1118). At Week 52, approximately 75% of guselkumab‐randomized patients with dactylitis at baseline had complete resolution; approximately 80% had at least 70% DSS improvement. Through Week 52, new‐onset dactylitis (DSS ≥1) was uncommon among patients with a DSS of 0 at baseline. Guselkumab‐randomized patients with dactylitis resolution were more likely to achieve ACR50, at least 50% reduction in tender and swollen joints, and LDA at Week 24 and Week 52 than those without resolution. At Week 52, patients with dactylitis resolution had numerically less radiographic progression from baseline (DISCOVER‐2). Conclusion Through 1 year, approximately 75% of guselkumab‐randomized patients had complete resolution of dactylitis; patients exhibiting resolution were more likely to achieve other important clinical outcomes. Given the high burden of dactylitis, resolution may be associated with better long‐term patient outcomes.

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“…Dactylitis, defined as a diffuse swelling of a digit (sausage-like digit), is a hallmark clinical feature in psoriatic arthritis (PsA) [1]. Dactylitis is also a marker of clinical severity and joint damage development in PsA [2]. On imaging, particularly on high-resolution ultrasound and magnetic resonance imaging (MRI), dactylitis consists of a variable combination of digital extra-synovial and synovial inflammatory lesions which may be accompanied by intra-or periarticular proliferative and erosive bone changes [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

What happens under the flexor tendons of the fingers in dactylitis?

et al. 2023

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Aim: Tenosynovitis is one of the most frequently described inflammatory lesions in psoriatic dactylitis. The aim of the study was to assess by ultrasound the distribution of content within the synovial sheath of the finger flexor tendons in a cadaveric experimental model of tenosynovitis and to describe anatomically the elements of the space between the flexor tendons and the palmar aspect of the proximal phalanx of the fingers.Material and method: Silicone was injected under ultrasound guidance into the digital flexor sheath of the index finger of a hand specimen. Ultrasound images of the distribution of the filling of the flexor synovial space with the injected material were obtained. These images were compared with images from patients with psoriatic dactylitis. The palmar regions of the hand and fingers were dissected to check the distribution of the injected silicone in the synovial cavity. Additionally, we dissected the 2nd to 5th fingers of five cadaveric hands, including the one used for the experiment.Results: During the injection of the substance, we observed an increasing homogeneous hypoechoic band around the flexor tendons that differed from the images of patients. Dissection of the specimen showed the injected silicone distributed throughout the digital flexor sheath to the distal interphalangeal joint. In addition, we provided an illustrated anatomical description of the elements located between the flexor tendons and the palmar aspect of the proximal phalanx, the inflammation of which could simulate flexor tenosynovitis.Conclusion: The observations of this study may contribute to a better understanding of the anatomical structures involved in PsA dactylitis.

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Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis

Cited by 17 publications

References 19 publications

Dactylitis and Early Onset Psoriasis in Psoriatic Arthritis: Are they Markers of Disease Severity? A Clinical Study

Dactylitis and Early Onset Psoriasis in Psoriatic Arthritis: Are they Markers of Disease Severity? A Clinical Study

Guselkumab, a Selective Interleukin‐23 p19 Subunit Inhibitor, Resolves Dactylitis in Patients With Active Psoriatic Arthritis: Pooled Results Through Week 52 From Two Phase 3 Studies

What happens under the flexor tendons of the fingers in dactylitis?

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