Pathophysiology, assessment and treatment of psoriatic dactylitis

McGonagle, Dennis; Tan, Ai Lyn; Watad, Abdulla; Helliwell, Philip S.

doi:10.1038/s41584-018-0147-9

Cited by 53 publications

(72 citation statements)

References 81 publications

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“…This detection supports the cardinal role of enthesitis observed in experimental models of PsA and in also some imaging studies 13 19. Moreover, previous observations showed that accessory pulley as mini-entheses may provide a mechanistic link between enthesitis and tenosynovitis but further work is needed 20 21. In this study, it is interesting to note that psoriatic nail involvement correlated with subclinical inflammation, but only in the arthralgia cohort.…”

Section: Discussionsupporting

confidence: 86%

Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia

et al. 2019

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ObjectiveNon-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition.MethodsA cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development.ResultsTenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, p<0.001), although synovitis and enthesitis were numerically more frequent in PsOAr. Five patients in PsOAr and one in PsO group developed PsA, with an incidence rate of 109.2/1000 person-years in PsOAr vs 13.4/1000 person-years in PsO (p=0.03). Visual Analogue Scale pain, Health Assessment Questionnaire, joint tenderness and US active enthesitis were baseline variables associated with PsA development.ConclusionTenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.

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Section: Discussionsupporting

confidence: 86%

Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia

et al. 2019

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“…Such heterogeneity poses challenges in management, particularly in deriving a sufficient evidence base to address clinical subtypes. Dactylitis is a hallmark of PsA1 for which therapeutic strategies remain empirical 2. Commonly, non-steroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections are employed 3.…”

Section: Introductionmentioning

confidence: 99%

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis

et al. 2020

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ObjectivesTo assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis.MethodsMulticentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint.ResultsTwenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy.ConclusionsThe combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis.Trial registration numberNCT02065713

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“…Dactylitis has variable associations to inflammatory lesions, including flexor tenosynovitis (FT), soft tissue oedema (STO), and joint synovitis [ 10 ]. However, these pathophysiological features of dactylitis can only be appreciated with advanced imaging with musculoskeletal-ultrasound (Msk-US) and magnetic resonance imaging (MRI) studies [ 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study

Girolimetto

Macchioni

Possemato

et al. 2020

JCM

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This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO).

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Pathophysiology, assessment and treatment of psoriatic dactylitis

Cited by 53 publications

References 81 publications

Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia

Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis

Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study

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