Dactylitis in psoriatic arthritis: a marker for disease severity?

Abstract

Aim: To describe dactylitis in a large cohort of patients with psoriatic arthritis followed prospectively in a specialist clinic, and identify whether it is associated with a worse prognosis. Methods: Between 1979 and 1999, 537 patients were registered in the psoriatic arthritis clinic and entered onto a longitudinal database. Patients were followed prospectively at six to 12 month intervals according to a standard protocol, and all information was entered onto a database. The database was searched for patients with dactylitis. Descriptive statistics were used to describe the population and x 2 tests to relate dactylitis to radiographic changes. Results: Dactylitis was documented in 260 patients (48%); 69% of the episodes were recorded at presentation to the clinic. Dactylitis affected feet only in 65% of cases, hands only in 24%, and both hands and feet in 12%. Recurrent dactylitis occurred in 44% of the patients. Increased radiological progression was noted in digits showing dactylitis compared with those without dactylitis (50% v 38%, respectively; p,0.0001). Conclusions: Dactylitis is common among patients with psoriatic arthritis. It most often affects the feet, in an asymmetrical distribution. It is associated with a greater degree of radiological damage than occurs in digits not affected by dactylitis. P soriatic arthritis is an inflammatory arthritis associated with psoriasis.

The Prevalence and Characteristics of Psoriatic Arthritis in Patients With Psoriasis in a Tertiary Hospital

“…19 Dactylitis is an important finding of PsA and is reported in between 12-48% of the patients. [20][21][22] In our study, we noted dactylitis in 22% of the patients.…”

Epidemiology, genetics and management of psoriatic arthritis 2013: focus on developments of who develops the disease, its clinical features, and emerging treatment options

“…This usually involves toes more than fingers in asymmetrical distribution, and leads to more severe radiological damage. 61 …”

“…58 Dactylitis is observed in all forms of spondyloarthropathies, with significant specificity in PsA, and this has been included in the classification criteria of PsA, eg, CASPAR criteria. 57 Dactylitis can be present in up to 48% of patients with PsA, 60,61 where this can be the first presentation of PsA, and for some time can remain the sole manifestation of this disease. This usually involves toes more than fingers in asymmetrical distribution, and leads to more severe radiological damage.…”

Severe psoriatic dactylitis: when psoriasis involves beyond the skin

“…Thus, disability in the workplace is very common in population with severe PsA (6), and it has a significant effect on the patient's quality of life and financial status. Classification criteria for PsA have set the specificity of dactylitis as one of the most discriminative musculoskeletal manifestation (7,8), and for yet unclear reasons, the risk for developing erosions in PsA seems to be higher in patients with dactylitis in comparison with those who show only arthritis (9). Traditionally, therapeutic approaches are not based on well-designed trials, but on empirical experiences.…”