Dactylitis: Pathogenesis and clinical considerations

Abstract

Dactylitis is considered a hallmark feature of psoriatic arthritis (PsA), but it is found in other spondyloarthropathies, especially reactive arthritis, and other conditions (eg, sarcoidosis, gout, sickle cell disease, and a variety of infections). Dactylitis is difficult to define and assess with any level of consensus and consistency in PsA. A new objective measure has been developed to make assessment more uniform for clinical trials. The underlying pathophysiology has also been difficult to determine in spondyloarthropathy: synovitis, tenosynovitis, and enthesitis have all been recognized. The pathophysiology in other conditions varies but usually involves soft tissue and sometimes involves bone or joint. In non-spondyloarthropathies,treatment is determined by the underlying cause. Research on dactylitis treatment in PsA suffers from a paucity of trials and inconsistent outcome measurement. The only drug with good evidence of benefit from randomized controlled trials thus far is infliximab.

Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis

“…This heterogeneity and breadth of clinical features make it hard to account for the whole spectrum of disease manifestations using a single instrument. Separate assessment of these manifestations may be preferable; indeed, measures for several characteristics have been validated and successfully applied in clinical trials, such as for skin,4 spinal,5 6 entheseal and nail involvement,2 6–8 and dactylitis 6 9…”

The place of musculoskeletal ultrasonography in gout diagnosis

“…The complex deposits of MSU in digits (tendon, subcutaneous tissue, etc) could create the aspect of gouty dactylitis, a rare finding, seen in chronic polyarticular disease [53][54][55].…”

Ultrasonography of the non-traumatic lesions of the fingers. Pictorial essay

“…The sickle cell dactylitis is due to bone marrow infarction, ("hand-foot syndrome"). Gouty dactylitis is a rare finding, seen in chronic polyarticular disease [2,5,9] (fig 10). Sarcoid dactylitis is a rare manifestation of sarcoidosis and tends to occur as the presenting symptom of the disease [9] (fig 11).…”

“…Gouty dactylitis is a rare finding, seen in chronic polyarticular disease [2,5,9] (fig 10). Sarcoid dactylitis is a rare manifestation of sarcoidosis and tends to occur as the presenting symptom of the disease [9] (fig 11). The deposition of calcium pyrophosphate or uric acid crystals in the flexor tendon sheath of the hand was found to be a rare cause for a swollen finger [10] (fig 12).…”