How Variable Is the Volar Subcutaneous Tissue of the Digits on B-Mode and Color Doppler Ultrasound in Non-Psoriatic Individuals and Could It Be Included in a Dactylitis Score?

Rebollo-Giménez, Ana; Martínez-Estupiñán, Lina; Olivas-Vergara, Otto; Fuensalida-Novo, Gema; Garrido, Jesús; Mejia, A. Rojo; Herrero‐Beaumont, Gabriel; Naredo, Esperanza

doi:10.1055/a-1168-6636

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…Additionally, prevalent use of NSAIDs at baseline (reported by 64% of patients with and 64% of patients without dactylitis) may have reduced pain and swelling in dactylitic joints, potentially confounding DSS measurements. The high prevalence of overweight and obesity in these studies (74% of patients had a BMI ≥25 kg/m 2 at baseline) may also have confounded dactylitis diagnosis and assessment, as BMI has been shown to be a source of variability in digital subcutaneous tissue thickness, and inflammation in this tissue is a characteristic feature of dactylitis ( 63 ). Despite these limitations, the predominant focus of the current analyses was dactylitis resolution, which is a rigorous binary endpoint.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…We weighted all components equally, but it could be argued that for example subcutaneous edema as the most frequent pathology should be scored semiquantitatively (22). This would increase its importance in a sum-score, and possibly enhance its sensitivity to change, although the applicability of such as score has been questioned, as subcutaneous ndings seem to be highly variable also in a non-psoriatic population (23).…”

Section: Discussionmentioning

confidence: 99%

Which ultrasound lesions contribute to dactylitis in psoriatic arthritis and their reliability in a clinical setting

2020

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Objectives. To investigate the prevalence of ultrasound elementary lesions in dactylitis in psoriatic arthritis (PsA), and the reliability of scoring these lesions in a clinical setting. Methods. In 31 patients with PsA and clinical dactylitis, ultrasound assessment of the affected digit was performed using grey-scale and color Doppler mode. One examiner scanned all patients and a 2nd examiner scanned 10 patients for inter-reader reliability. The following lesions were evaluated: subcutaneous edema; soft tissue thickening; synovitis of the digital joints; tenosynovitis of the exor tendon; enthesitis at the deep exor tendon and the extensor tendon entheses; and paratenonitis of the extensor tendon. A dactylitis sum-score was calculated. Findings in clinically tender and non-tender digits were compared. Results. The most frequent lesions were soft tissue thickening (81%) and subcutaneous edema (74%) followed by synovitis (56-68%) and exor tenosynovitis (52%). Color Doppler was most frequently found subcutaneously (55%) and around the exor tendons (45%). All lesions were typically found in combinations, most commonly subcutaneous edema and synovitis (71%), subcutaneous edema and exor tenosynovitis (52%), and all three in combination (52%). Tender digits had a higher dactylitis sumscore and numerically higher prevalence of most lesions than non-tender digits. Intra-and inter-reader agreements were moderate to excellent, though lower for few components of digital enthesitis, especially hypoechogenicity. Conclusion. Dactylitis in PsA appears to encompass several pathologies, most often subcutaneous changes combined with synovitis and/or exor tenosynovitis. Reliability of scoring established ultrasound lesions of dactylitis in a clinical setting is moderate-excellent.

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“…Recently, STOe was sonographically defined as "abnormal hypoechoic/anechoic areas, diffused or localized within the subcutaneous tissue between the epidermis and the tendon-related anatomic structures, with local thickening, with or without local abnormal Doppler signal, visualized in two perpendicular planes, and not present on the contralateral side" [42,43]. The comparison with a digit not affected by the disease (contralateral or adjacent) is a fundamental step in the sonographic evaluation of STOe since subcutaneous tissue thickness is highly variable and dependent on an individual's baseline [44]. Studies from our group reported that STOe was present in 75-91% of hand dactylitis (and associated with PD signal in 69-82% of cases) [8,9,38,39].…”

Section: Imaging Of Hand Dactylitismentioning

confidence: 99%

Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging

Girolimetto

Giovannini

Crepaldi

et al. 2021

JCM

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Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the articular synovium; the small enthesis of the hands. Dactylitis is currently considered both a marker of disease activity and severe prognosis and its importance in PsA is emphasized by the inclusion in the classification criteria of PsA. This review focuses on the role of imaging in the management of PsA patients with dactylitis in clinical practice and in a research setting. Furthermore, imaging could be a valuable tool to assist in unravelling some of the underlying mechanisms of the onset and chronicization of dactylitis in PsA patients.

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How Variable Is the Volar Subcutaneous Tissue of the Digits on B-Mode and Color Doppler Ultrasound in Non-Psoriatic Individuals and Could It Be Included in a Dactylitis Score?

Cited by 5 publications

References 27 publications

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

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

Which ultrasound lesions contribute to dactylitis in psoriatic arthritis and their reliability in a clinical setting

Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging

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