Fast spin echo–T2‐weighted sequences with fat saturation in dactylitis of spondylarthritis

Abstract

Objective. To establish by means of fast spin echo (FSE)-T2-weighted sequences with fat saturation if enthesitis of the flexor digitorum superficialis and profundus tendons is the primary lesion in spondylarthritis (SpA) finger dactylitis.Methods. Eleven dactylitic fingers and their corresponding normal, contralateral fingers, belonging to 6 patients who met the Amor criteria for SpA, were studied by FSE-T2-weighted sequences with fat saturation.Results. All dactylitic fingers showed moderate or severe fluid collection in the flexor tendon synovial sheaths. Involvement of the joint cavity was simultaneously present in at least one joint in 3 (27.3%) of the 11 fingers. A mild to moderate peritendinous soft tissue edema was observed in 5 (45.5%) of the 11 affected fingers. In no dactylitic finger was bone edema observed near the insertions of the flexor digitorum superficialis or profundus tendons or in other sites of the phalanges. No lesions were observed in the 11 contralateral, clinically normal fingers.Conclusion. In SpA dactylitis there is no evidence

Dactylitis: Pathogenesis and clinical considerations

“…Further publications showed flexor tendon sheath involvement [20][21][22]. A more recent paper with higher power MRI (1.5 T) again supported the role of flexor tenosynovitis in dactylitis [23]. In this study, no evidence of enthesitis at flexor or extensor tendon insertions was found.…”

MRI in psoriatic arthritis: Insights into pathogenesis and treatment response

“…Olivieri et al [20][21][22] have described several MRI series of patients with dactylitis involving the fi ngers and toes and have demonstrated that tenosynovitis, usually with effusion, is a major component. Flexor tendons were more often involved than extensor tendons, and they found concomitant small joint synovitis to be relatively uncommon (6%-27% of cases).…”

Imaging of Psoriatic Arthritis

“…In the past, it was thought that the sausage-like appearance was due to concomitant flexor tenosynovitis and arthritis of the metacarpophalangeal (or metatarsophalangeal) and interphalangeal joints. Recent US and MRI studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and marked adjacent soft tissue swelling with a variable degree of small joint synovitis (27)(28)(29)(30)(31). Flexor tenosynovitis was always present while joint synovitis occurred in 17-62% of the sausage shaped digits.…”

“…In their opinion, the flexor tenosynovitis of dactylitis is due to enthesitis as a consequence of the diffusion of cytokines along the tenosynovial sheaths (33). A recent study has demonstrated, by using fast spin echo (FSE)-T2-weighted sequences with fat saturation, that in SpA dactylitis there is no evidence of enthesitis of the insertion of the flexor digitorum tendons and of the attachment of the caspsule of the digit joints (29). However, Mc Gonagle and his colleagues have suggested that in dactylitis enthesitis could occur at the numerous "functional entheses" that the digit flexor tendons forms with retinacula or pulleys (34).…”