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Dactylitis is a clinical concept that corresponds to the swelling of the whole finger or toe giving a sausage appearance. Although it can be observed in different diseases, it is a distinctive clinical feature of psoriatic arthritis and is associated with a poor prognosis. Ultrasound has made it possible to improve our understanding of the pathogenesis of psoriatic arthritis dactylitis, identifying associated structural alterations, namely, flexor tenosynovitis, subcutaneous tissue edema, pulley inflammation with thickening and intra-pulley Doppler signals, extensor paratenonitis, synovitis, pericapsular bone formation, and flexor enthesitis. Given its complexity, a consensus has yet to be reached on an ultrasound-based definition of dactylitis. In addition, enthesitis is one of the characteristic features of spondyloartritis. Enthesitis, like dactylitis, is among the clinical manifestations in the Assessment of SpondyloArthritis international Society classification criteria for both axial and peripheral spondyloartritis and is a key feature for classifying psoriatic arthritis with the Classification criteria for Psoriatic Arthritis criteria. Ultrasonography is a very useful tool for exploring the enthesis. We have a good sonographic definition, although ultrasound findings do not always allow us to differentiate between mechanical or inflammatory lesions. Elementary lesions that characterize enthesopathy are hypoechogenicity at the enthesis, thickened enthesis, calci ficat ion/e nthes ophyt e at enthesis, erosion at enthesis, and Doppler signal at enthesis. Different composite indices have been proposed in order to classify spond yloar throp athie s. This article reviews the evaluation of dactylitis and enthesitis from the sonographic perspective. [ABSTRACT FROM AUTHOR]

Objectives To describe the clinical features and treatment outcomes of children with juvenile psoriatic arthritis (JPsA) and compare the distinct patterns of the disease between early-onset and late-onset age groups. Methods Patients with JPsA followed regularly for at least 6 months between 2010 and 2020 in seven paediatric rheumatology centres in Turkey were included in the study. The demographic features, clinical manifestations, treatment strategies and outcomes of the patients were evaluated retrospectively. Results A total of 87 (46 male/41 female) patients were included in the study. The mean age at diagnosis was 11.9 years (s. d. 4.5). Fifty-seven (65.5%) patients had psoriasis at the time of diagnosis and arthritis preceded psoriasis in 10 (11.5%) patients. Thirty (34.5%) patients had dactylitis, 28 (32.2%) had nail pitting, 36 (41.4%) had involvement of the small joints and 20 (23%) had enthesitis. Sacroiliitis was detected in 11 (12.6%) patients by MRI. ANA was positive in 35 (40.2%) patients. Twelve children (13.8%) were in the early-onset (<5 years) group. Uveitis and ANA positivity were more common in the early-onset group. Active joint counts and activity scores of our patients showed significant improvement at month 6 and at the last control compared with baseline. Conclusion About one-third of patients with JPsA do not have psoriasis at the time of diagnosis. In some patients, no skin lesion is seen during the course of the disease. Children with PsA seem to display two different phenotypes. Younger children have a female predominance, ANA positivity and uveitis, while older children have more axial involvement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features. We conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient. Foot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy. [ABSTRACT FROM AUTHOR]

Due to their primary and well-known antiresorptive activity, bisphosphonate (BPs) are commonly prescribed as first-line drugs for osteoporosis treatment. Some reports suggest that they may also possess immunomodulatory and anti-inflammatory properties, along with potential benefits in preventing structural joint damage in inflammatory rheumatic diseases. However, despite the promising outcomes observed with BP use in treating rheumatic disorders, numerous reports have implicated these drugs as potential contributors to the development of arthritis. In this case report, two female patients aged 71 and 55 years who developed arthritis in the wrist and dactylitis in the finger after zoledronic acid infusion are presented. This study is significant because, to our knowledge, one of our patients is the first to have been diagnosed with dactylitis, and the other case is one of the few cases in the literature presenting oligoarticular involvement of joints after zoledronic acid administration. [ABSTRACT FROM AUTHOR]

Due to their primary and well-known antiresorptive activity, bisphosphonate (BPs) are commonly prescribed as first-line drugs for osteoporosis treatment. Some reports suggest that they may also possess immunomodulatory and anti-inflammatory properties, along with potential benefits in preventing structural joint damage in inflammatory rheumatic diseases. However, despite the promising outcomes observed with BP use in treating rheumatic disorders, numerous reports have implicated these drugs as potential contributors to the development of arthritis. In this case report, two female patients aged 71 and 55 years who developed arthritis in the wrist and dactylitis in the finger after zoledronic acid infusion are presented. This study is significant because, to our knowledge, one of our patients is the first to have been diagnosed with dactylitis, and the other case is one of the few cases in the literature presenting oligoarticular involvement of joints after zoledronic acid administration.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The presence (vs absence) of enthesitis/dactylitis is associated with greater psoriatic arthritis (PsA) activity and reduced health-related quality of life. Risankizumab, an interleukin 23 antagonist, demonstrated superior treatment efficacy over placebo in patients with PsA, including enthesitis/dactylitis. Herein, we report the efficacy of risankizumab on complete resolution of enthesitis and/or dactylitis and improvements in patient-reported outcomes in patients with PsA. Methods: This integrated post hoc analysis of data from KEEPsAKE 1 and KEEPsAKE 2 included patients with baseline enthesitis (Leeds Enthesitis Index > 0) and/or dactylitis (Leeds Dactylitis Index > 0). Efficacy outcomes at weeks 24 and 52 included proportion of patients achieving enthesitis and/or dactylitis resolution and minimal clinically important differences (MCID) in pain, Health Assessment Questionnaire-Disability Index, and Functional Assessment of Chronic Illness Therapy-Fatigue. Results: Of 1407 patients, approximately 63%, 28%, and 20% had baseline enthesitis, dactylitis, and both enthesitis/dactylitis, respectively. At week 24, higher response rates were observed for risankizumab vs placebo for resolution of enthesitis, dactylitis, and both enthesitis/dactylitis (differences of 13.9%, 16.9%, and 13.3%, respectively; p < 0.05). By week 52, risankizumab treatment resulted in complete resolution of enthesitis, dactylitis, and both enthesitis and dactylitis in 55.0%, 76.1%, and 52.3% of patients; similar resolution rates occurred among patients who switched from placebo to risankizumab. Among risankizumab-treated patients who achieved resolution of enthesitis and/or dactylitis, MCIDs were also attained in patient-reported pain, disability, and fatigue at week 24 (all p < 0.05; except fatigue in patients with resolution of both enthesitis/dactylitis); responses were sustained through week 52. Conclusions: Higher proportions of risankizumab-treated (vs placebo-treated) patients achieved enthesitis and/or dactylitis resolution and meaningful improvements in patient-reported outcomes at week 24 and generally sustained responses at week 52. Thus, risankizumab may result in sustained alleviation of PsA-related pathognomonic musculoskeletal lesions of enthesitis/dactylitis. Clinicaltrials.gov identifiers: NCT03675308, and NCT03671148. [ABSTRACT FROM AUTHOR]

This article presents two cases of rare forms of tuberculosis affecting the musculoskeletal system. In the first case, a 42-year-old male presented with swelling and pain in the hand joints, which was initially misdiagnosed and did not respond to treatment. Further examination revealed the presence of skin lesions and the patient was eventually diagnosed with tuberculous dactylitis. The second case involved a patient with thigh pain, initially suspected to be malignancy, but was later diagnosed as tuberculous pyomyositis. Both cases highlight the importance of considering tuberculosis as a possible diagnosis in patients with unusual musculoskeletal symptoms. The article emphasizes the need for a multidisciplinary approach in diagnosing and treating these rare forms of tuberculosis. [Extracted from the article]

Chronic granulomatous disease is a rare primary immunodeficiency seen in 1/70,000-1/200,000 births. It is a monogenetic disease caused by defects in the nicotinamideadenine-dinucleotide-phosphate oxidase enzyme complex. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase produces reactive compounds necessary for the lysis of phagocytized microorganisms. Defects in the NADPH oxidase enzyme complex predispose to granuloma formation and the development of lifethreatening recurrent bacterial and fungal infections. Infections usually occur with involvement of the lungs, lymph nodes, liver, bone and skin. Rarely, it may present with dactylitis. A case of chronic granulomatous disease presenting with dactylitis in the third finger of the left hand and abscess on the wrist. The patient who didn’t respond to empirical antibiotic treatment was referred to our hospital. Serratia marcescens was detected in the drained abscess. After the detection of Serratia marcescens, which we see rarely as a causative agent, in the wound culture, the detection of granulomatous inflammation in the biopsy and the NBT test: 0%; the patient was diagnosed with chronic granulomatous disease. Significant regression was observed in the lesion after ceftriaxone and gentamicin treatment given for 14 days. Recurrent and/or unusually severe infections, particularly abscesses and infections commonly caused by CGD-associated pathogens, should suggest chronic granulomatous disease. Early screening of potentially affected children; early diagnosis as well as timely antimicrobial therapy followed by adequate antimicrobial prophylaxis will prevent infectious relapses and sequelae.

We present a rare case of sarcoid dactylitis after an adult female presented with painless swelling of the bilateral hand fingers and toe, with radiographic findings highly characteristic for osseous sarcoidosis and confirmation made by bronchoscopic biopsy of hilar enlarged lymph nodes.

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Abstract Acrodermatitis continua of Hallopeau (ACH) is a rare variant of acral pustular psoriasis, exclusively involving the distal phalanges and nails of the hands and feet. We herein report a rare case of concurrent ACH and psoriatic arthritis sine psoriasis presenting with dactylitis. The patient was successfully treated with biologics and apremilast.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians’ understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.

Teaching point: Magnetic resonance imaging (MRI) and ultrasound may be useful to assess the extent of onychodystrophy associated with psoriatic dactylitis by showing nail bed thickening, matrix changes, and vascularity indicative of active inflammation.

Resumen: La dactilitis o dedo en salchicha, se define como la inflamación de uno o varios dedos de las manos o de los pies. La dactilitis sarcoidea es una forma poco frecuente de dactilitis, que suele ser debida a la afectación ósea granulomatosa a nivel de las falanges subyacentes. Sin embargo, una apariencia clínica similar puede ser debida a la presencia de una sarcoidosis subcutánea en los dedos. Describimos los casos de 5 pacientes con una dactilitis por una sarcoidosis subcutánea de los dedos. En nuestros pacientes, las lesiones se localizaron en las falanges proximales a diferencia de la dactilitis sarcoidea por afectación ósea, que suele localizarse en las falanges medias y distales. Es importante el diagnóstico diferencial puesto que la dactilitis por afectación ósea suele ser mucho más persistente y asociarse a formas crónicas de sarcoidosis. Abstract: Dactylitis, or sausage fingers or toes, refers to the swelling of 1 or more digits. Sarcoid dactylitis is an uncommon form that tends to be caused by granulomatous bone involvement in the underlying phalanges. Sarcoid dactylitis can, however, clinically resemble subcutaneous sarcoidosis with finger or toe involvement. We describe 5 patients with dactylitis due to subcutaneous sarcoidosis of the fingers. In all cases, the proximal phalanges were involved; sarcoid dactylitis, by contrast, tends to affect the medial and distal phalanges. Differential diagnosis is important, as dactylitis due to bone involvement tends to be much more persistent and is generally seen in chronic forms of sarcoidosis.

Introduction: Enthesitis and dactylitis are difficult-to-treat features of psoriatic arthritis (PsA), leading to disability and affecting quality of life. Objective: The aim of this study is to evaluate enthesitis (using the Leed enthesitis index (LEI)) and dactylitis at 6 and 12 months in patients treated with apremilast. Methods: Patients affected by PsA from fifteen Italian rheumatological referral centers were screened. The inclusion criteria were: (a) enthesitis or dactylitisphenotype; (b) treatment with apremilast 30 mg bid. Clinical and treatment history, including PsA disease activity, were recorded. Mann–Whitney and chi-squared tests were used to assess the differences between independent groups, and Wilcoxon matched pairs signed-rank test assessed the differences between dependent samples. A p-value of <0.05 was considered statistically significant. Results: The Eph cohort consisted of 118 patients (median LEI 3); the Dph cohort included 96 patients with a median dactylitis of 1 (IQR 1–2). According to an intention to treat analysis, 25% and 34% of patients with enthesitis achieved remission (i.e., LEI = 0) in T1 and T2. The remission of dactylitis was 47% in T1 and 44% in T2. The per protocol analysis (patients observed for at least 12 months) showed that both dactylitis and LEI significantly improved in T1 (median LEI 1 (IQR 1–3)) and T2 (median LEI 0 (IQR 1–2)). Conclusion: Eph and Dph PsA patients treated with apremilast experienced a significant improvement in enthesitis and dactylitis activity. After 1 year, enthesitis and dactylitis remission was achieved in more than one-third of patients. [ABSTRACT FROM AUTHOR]

Objective: Up to now, the pathophysiology of SpA dactylitis has not been entirely clarified. It is not clear which are the involved tissues and which is the primary lesion of the "sausage-like" digit. The aim of our study was to examine the finger structures in early-onset finger dactylitis using high-resolution microscopy MRI together with morphologic and dynamic MRI. Subjects and methods: In a 6-month period, 13 SpA patients (7 females and 6 males), mean age 54.07 years (range 37–73 years) and mean disease duration 7.07 years (range 1–44 years) with early-onset finger dactylitis (less than 3 months) were recruited. Nine patients had PsA, 3 HLA-B27-positive uSpA and 1 HLA-B27-negative uSpA. One patient had 2 dactylitis fingers. Ten healthy volunteers matched for age and sex with no personal and family history of SpA were enrolled. All dactylitis fingers and randomly selected fingers of the normal control subjects were imaged by morphologic, dynamic and high-resolution microscopy MRI. Results: We have found flexor tenosynovitis in all the 14 dactylitis fingers, joint synovitis in 5 and oedema in the finger soft tissue in 10. In 2 dactylitis fingers, there was oedema at the insertion of the joint capsule suggesting enthesitis. In 5 dactylitis fingers, there was only mild enhancement at the enthesis organ (collateral ligament, flexor and extensor tendons). Conclusions: Our MRI study on early-onset dactylitis demonstrates that flexor tenosynovitis, joint synovitis and oedema of the digit soft tissue are the predominant alterations visible in the early phase of evolution of dactylitis and that, therefore, enthesitis may not be considered the primary lesion of dactylitis. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a very rare disease from the hyperkeratotic papulosquamous disorder group. The rheumatologic manifestations of PRP are extremely rare and less known to clinicians than those of psoriasis. An interesting case of inflammatory arthritis in the hand of an adolescent patient who was successfully treated with adalimumab and compatible with the diagnosis of type IV circumscribed juvenile PRP is presented in the light of the literature. [ABSTRACT FROM AUTHOR]

To evaluate the effect of the phosphodiesterase 4 inhibitor apremilast in biologic-naïve patients with early peripheral PsA in terms of disease activity, clinical manifestations, patient-perceived outcomes, as well as apremilast's safety profile in routine care settings of Greece. Non-interventional, multicenter, 52-week prospective cohort study, enrolling biologic-naïve patients with early active peripheral PsA who started apremilast after intolerance or inadequate response (within the first 12 months of treatment) to an initial conventional synthetic (cs)DMARD treatment. Non-responder imputation was applied for missing data.In total, 167 consecutive patients (mean age: 52.5 years; median PsA duration: 0.9 years) were analyzed. At baseline, the median (interquartile range) clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score was 22.0 (16.0–29.0), with 86.8% of patients having at least moderate (29.3% high) disease activity; 87.4% had skin psoriasis, 37.7% nail psoriasis, 30.7% enthesitis, and 12.4% dactylitis. At 16, 24, and 52 weeks, 28.7, 42.5, and 48.5% of patients, achieved ≥ 50% improvement in their baseline cDAPSA score, respectively. At week 52, 55.6, 50, and 26.8% of evaluable patients achieved complete resolution of enthesitis, dactylitis and nail psoriasis, respectively. Improvements were also observed in patient's health state assessed by the Psoriatic Arthritis Impact of Disease 12-item questionnaire, and health-related quality of life. The 52-week drug survival rate was 75%, while 13.8% of patients experienced at least one adverse drug reaction.Biologic-naïve patients with early PsA, treated with apremilast experienced significant improvements in disease activity, extra-articular manifestations and patient-centered outcomes, accompanied by a favorable tolerability profile. [ABSTRACT FROM AUTHOR]

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RETRACTED ARTICLEThe goal of this article is to provide an overview and comparison of published data on PsA with information obtained in the survey. A survey was conducted of 24 patients with PsA. Identified terms of formation of articular and cutaneous syndromes in PsA in children, as well as options for debut and height of the disease are presented. The brief characteristic of therapy is given. The data obtained svidedelstvuyut that for PsA in children was different: the debut changed the structure and height of the disease, the timing of the formation of cutaneous and articular syndrome, and this disease was more likely to suffer for young children.

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis and characterized by various presentation, course, and response to treatment. A better understanding of the pathogenesis has led to the development of targeted therapeutic agents and innovative treatment strategies for PsA. The article is dedicated to a drug targeting interleukin-17A. Secukinumab is a fully human monoclonal antibody that selectively targets interleukin (IL) 17A, a pro-inflammatory cytokine involved in the pathogenesis of PsA. Secukinumab is the first antibody against IL 17 approved in many countries for PsA treatment in adult patients. In the Phase III FUTURE trial, secukinumab 150 and 300 mg subcutaneously showed high efficacy on disease activity in patients previously treated with non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and / or tumor necrosis factor (TNF) inhibitors and maintaining the effect for a long time of treatment (more than 5 years). In addition, in studies FUTURE 1 and 5 secukinumab suppressed structural joint damage and was associated with consistently low rates of radiological progression after 1–3 years of treatment. Treatment with secukinumab improved physical function and quality of life and was generally well tolerated in both short and long term. Secukinumab is effective in all key PsA domains and therefore represents a treatment option that may be an alternative to TNF inhibitors and other DMARDs in adult patients with PsA.

Abstract Background Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). This post-hoc analysis of two phase III studies in patients with PsA treated with tofacitinib assessed dactylitis by location, and the impact on patient-reported outcomes (PROs). Methods Patients received tofacitinib 5 or 10 mg twice daily (BID), or placebo. Endpoints included change from baseline in Dactylitis Severity Score (DSS), proportions of patients with dactylitis, Psoriatic Arthritis Disease Activity Score (PASDAS), and PROs (Health Assessment Questionnaire-Disability Index [HAQ-DI]; Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]; Short Form-36 Health Survey [SF-36] Physical Component Summary [PCS], Mental Component Summary [MCS], and physical functioning [PF]; arthritis pain; and Work Limitations Questionnaire [WLQ]). Descriptive statistics were generated by visit and treatment. Change from baseline in PROs were evaluated by multivariate linear regression. Results The analysis included 373/337 patients with baseline DSS > 0/DSS = 0. Regardless of location, DSS improvements in patients with DSS > 0 were greater from month 1 with tofacitinib (10 mg BID) versus placebo. For patients with DSS > 0/DSS = 0, both doses of tofacitinib led to mean dactylitis presence ≤ 15%/

Objective: This literature review aimed to identify the most efficacious current interventions for dactylitis and provide up-to-date scientific evidence to support the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations on the management of psoriatic arthritis.Methods: Original articles published from 2013 to 2020, registered in MEDLINE, Embase, and Cochrane Library, describing interventional trials and reporting dactylitis-related outcomes were included. The 20 members of the GRAPPA dactylitis group were divided into 9 subgroups according to treatment, and members of each group independently extracted data from articles/abstracts corresponding to their group by using a standardized data extraction form.Results: Forty-nine publications were analyzed, representing 40 randomized clinical trials (RCTs) and including 16,752 patients. Dactylitis was assessed as a secondary outcome in 97.5% of these trials and more than 40% of RCTs did not employ a specific dactylitis measure or instrument.Conclusion: The emergence of agents with novel mechanisms of action in recent years, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, has significantly expanded the available treatment options for dactylitis. This article points out the lack of consensus regarding dactylitis assessment and the paucity of data concerning the effect of local steroid injections, nonsteroidal antiinflammatory drugs, and conventional disease-modifying antirheumatic drugs. Clinical trials evaluating the effect of these traditional and low-cost medications used to treat dactylitis should be encouraged. [ABSTRACT FROM AUTHOR]

Aim: Tenosynovitis is one of the most frequently described inflammatory lesions in psoriatic dactylitis. The aim of the study was to assess by ultrasound the distribution of content within the synovial sheath of the finger flexor tendons in a cadaveric experimental model of tenosynovitis and to describe anatomically the elements of the space between the flexor tendons and the palmar aspect of the proximal phalanx of the fingers. Material and method: Silicone was injected under ultrasound guidance into the digital flexor sheath of the index finger of a hand specimen. Ultrasound images of the distribution of the filling of the flexor synovial space with the injected material were obtained. These images were compared with images from patients with psoriatic dactylitis. The palmar regions of the hand and fingers were dissected to check the distribution of the injected silicone in the synovial cavity. Additionally, we dissected the 2nd to 5th fingers of five cadaveric hands, including the one used for the experiment. Results: During the injection of the substance, we observed an increasing homogeneous hypoechoic band around the flexor tendons that differed from the images of patients. Dissection of the specimen showed the injected silicone distributed throughout the digital flexor sheath to the distal interphalangeal joint. In addition, we provided an illustrated anatomical description of the elements located between the flexor tendons and the palmar aspect of the proximal phalanx, the inflammation of which could simulate flexor tenosynovitis. Conclusion: The observations of this study may contribute to a better understanding of the anatomical structures involved in PsA dactylitis. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the clinical characteristics, disease burden, and treatment patterns of peripheral spondyloarthritis (pSpA) patients with and without psoriasis using data from the ASAS-perSpA study. Methods We included 433 patients who had a diagnosis of pSpA according to the rheumatologist's diagnosis from the ASAS-PerSpA study. The presence of a personal history of psoriasis was defined as the presence of signs of psoriasis at physical examination or the presence of psoriatic nail dystrophy, including onycholysis, pitting and hyperkeratosis, or a history of psoriasis diagnosed by a physician. Clinical characteristics, patient-reported outcomes and treatment pattern were compared between subgroups with and without psoriasis. Results A total of 83 patients (19.2%) had a personal history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years), a higher frequency of dactylitis (36.1 vs 20.0%) and enthesitis (65.1 vs 55.4%) than patients without psoriasis. A longer diagnostic delay (odds ratio [OR] = 1.06 [95% CI 1.01, 1.11]), lower odds for HLA-B27 positivity (OR = 0.31 [95% CI 0.15, 0.65]) and higher odds for enthesitis (OR = 2.39 [95% CI 1.16, 4.93]) were associated with the presence of psoriasis in a multivariable regression analysis. While patient-reported outcomes were comparable between groups, a higher use of biologic DMARDs was observed in patients with vs without psoriasis. Conclusion The presence of psoriasis has an impact on clinical characteristics of pSpA. pSpA patients without psoriasis were less frequently treated with biologic DMARDs despite similar disease burden as compared with patients with psoriasis. [ABSTRACT FROM AUTHOR]

L'échographie articulaire est devenue un examen incontournable pour la prise en charge des patients présentant un rhumatisme inflammatoire chronique. En plus de la synovite, les lésions tendineuses inflammatoires telles que la ténosynovite, la paratendinite, l'enthésite et la dactylite, ont été bien définies en échographie depuis plus de 10 ans. Ces lésions sont reproductibles, sensibles au changement et permettent l'étude des tendons aussi bien dans les études cliniques que dans la vie courante. La recherche d'une ténosynovite aide au diagnostic d'un rhumatisme inflammatoire persistant, et sa présence prédit la progression structurale chez les patients présentant une arthrite débutante. L'analyse fine des lésions tendineuses permet de mieux différencier la polyarthrite rhumatoïde du rhumatisme psoriasique. L'étude des tendons de la main en échographie est ainsi un complément indispensable de l'évaluation articulaire dans les RIC pour améliorer leur prise en charge. Musculoskeletal ultrasound is an imaging technique widely used in inflammatory arthritis patients. In addition to synovitis, tendon damage and tendon inflammation, such as tenosynovitis, paratendinitis, enthesitis and dactylitis have been defined by ultrasound for more than 10 years. Reliability and responsiveness were evaluated and allows tendon examination both in clinical research and in routine practice. US-defined tenosynovitis provided independent predictive data for persistent RA development and its presence predicts erosive progression in patients with early arthritis. Detailed study of tendon damage allows to better distinguish rheumatoid arthritis from psoriatic arthritis. Tendon evaluation by ultrasound could improve management of inflammatory arthritis. [ABSTRACT FROM AUTHOR]

Objectives: Psoriatic arthritis (PsA), is a complex inflammatory arthropathy with a heterogenous spectrum of disease presentation. Despite the vast therapeutic armamentarium, disease control in a considerable proportion of patients is suboptimal. The aim of this study was to assess the safety and efficacy of Janus kinase inhibitors (JAKi), in the management of key clinical domains of PsA including peripheral arthritis, psoriasis, enthesitis and dactylitis. Method: Randomized placebo‐controlled trials (RCTs) of JAKi in PsA were identified by a systematic literature search using EMBASE, PubMed and CENTRAL. All included studies underwent meta‐analysis. Results: A total of 5 RCTs were included. Patients were randomized to tofacitinib (n = 474), filgotinib (n = 65), upadacitinib (n = 1281) or placebo (n = 937). JAKi treatment was associated with superior efficacy across all primary outcome measures vs placebo: American College of Rheumatology (ACR) 20 (risk ratio [RR] 2.10, [95% CI 1.86–2.37], P <.00001, I2 = 19%); ACR 50 (RR 3.43, [95% CI 2.37–4.96], P <.00001, I2 = 66%); ACR 70 (RR 4.57, [95% CI 1.83–11.44], P =.001, I2 = 82%); Psoriasis Area and Severity Index 75 (RR 2.96, [95% CI 2.44–3.58], P <.00001, I2 = 0%); enthesitis resolution (RR 1.82, [95% CI 1.56–2.12], P <.00001, I2 = 0%); and dactylitis resolution (RR 1.85, [95% CI 1.57–2.16], P <.00001, I2 = 0%). JAKi were associated with an overall increased risk of adverse events (RR 1.14, [95% CI 1.07–1.21], P =.0001, I2 = 0%) with increased risk of infection (RR1.23, [95% CI 1.08–1.39], P =.001, I2 = 0%) vs placebo. Conclusion: This pooled analysis demonstrates the efficacy of JAKi in treating key clinical domains of PsA. However, they are associated with an increased risk of adverse events, including infection. Further studies are required to corroborate these findings and further elucidate the safety profile. [ABSTRACT FROM AUTHOR]

Background: Peripheral spondyloarthritis (pSpA) is usually associated with psoriasis, inflammatory bowel disease, or preceding infection (called reactive arthritis). Pure pSpA is a clinical entity wherein there are enthesitis, dactylitis, or arthritis, without any of the above-associated conditions. We aimed to describe the clinical, laboratory, radiological, and management profile of pure pSpA, among patients with pSpA presenting to the rheumatology outpatient department. Materials and Methods: In this retrospective, observational study, medical records of all the patients diagnosed as pSpA by a rheumatologist, between January 1, 2016, and December 31, 2018, were included. Among these, thirty patients qualified to be called pure pSpA, and we reported their demographic characteristics (age and sex), clinical features (onset of disease, clinical signs, and symptoms), laboratory parameters (erythrocyte sedimentation rate, hemoglobin, and C-reactive protein), radiological findings, and treatment pattern. Results: Thirty patients fulfilled the criteria for pure pSpA. The mean age (standard deviation) of the patients at onset was 32 ± 5.8 years. The mean disease duration before diagnosis was 9.7 months. Arthritis, enthesitis, and dactylitis were present in 29 (96.7%), 8 (26.7%), and 9 (30%) patients, respectively. Eighteen (60%) patients had monoarthritis, while 11/30 (36.7%) had oligoarthritis, at presentation. HLA B27 was positive in 24/30 (80%) patients. Seven patients (23.3%) had bilateral sacroiliitis on imaging and two (6.7%) had unilateral sacroiliitis. Twenty patients (66.7%) required conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), while two (6.7%) required biological DMARDs in the form of anti-tumor necrosis factor-alpha inhibitors. Conclusion: Pure pSpA is a relatively rare clinical disease which presents with either a mono or oligoarthritis and shows good treatment response to csDMARDs.

The article discusses the 2022 British Society for Rheumatology (BSR) guidelines for the use of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in the treatment of patients with psoriatic arthritis (PsA). Topics explored include the clinical characteristics and prevalence of PsA, the patient outcomes associated with treat-to-target PsA management, and the DMARDs treatment and prescribing strategies that need to be considered by clinicians.

The article discusses the 2022 British Society for Rheumatology (BSR) guidelines for the use of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in the treatment of patients with psoriatic arthritis (PsA). Topics explored include the clinical characteristics and prevalence of PsA, results of randomized clinical trials of synthetic DMARDs, and the DMARDs prescribing and treatment strategies.

Objective: To investigate the association of dactylitis with disease activity and the severity of damage detected by radiography in patients with axial psoriatic arthritis (axPsA).Methods: Patients with axPsA who met the Classification Criteria for Psoriatic Arthritis were recruited. Clinical data, radiographic changes, and disease activity in patients with axPsA with or without dactylitis were compared using t tests, Mann-Whitney U tests, or Kruskal-Wallis tests for continuous variables. Chi-square or Fisher exact tests were used for categorical variables, and logistic regression analysis was performed to evaluate the association between dactylitis and damage detected by radiography.Results: A total of 186 patients with axPsA were analyzed and dichotomized according to the presence or absence of dactylitis. Patients with dactylitis, as compared to those without dactylitis, had higher C-reactive protein (P = 0.004), erythrocyte sedimentation rate (P = 0.006), neutrophil-to-lymphocyte ratio (P = 0.04), and platelet-to-lymphocyte ratio (P = 0.02). In addition, patients with dactylitic axPsA, as compared to patients with nondactylitic axPsA, had higher tender joint counts, swollen joint counts, Disease Activity Index for Psoriatic Arthritis (DAPSA) scores, and Health Assessment Questionnaire scores (P < 0.001). Patients with axPsA who had dactylitis, as compared to those who did not, also had higher values for the Disease Activity Score in 28 joints, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Disease Activity Index (P < 0.05), while fewer of these patients met the criteria for minimal disease activity and low disease activity (P < 0.05). Consistently, they had more severe damage as detected by radiography (P < 0.05), higher sacroiliac scores (odds ratio [OR] 2.08, 95% CI 1.14-3.79; P = 0.02), and a more significant reduction in bone mass density (OR 2.42, 95% CI 1.34-4.37; P = 0.003). No statistical differences were observed regarding HLA-B27 and the Leeds Enthesitis Index between these 2 groups of patients. Notably, only half of the patients with dactylitic axPsA had inflammatory back pain.Conclusion: Our study demonstrated that patients with axPsA who had dactylitis had higher disease activity and more severe joint damage compared to those without dactylitis. Careful examination and proper management of axial involvement are recommended. [ABSTRACT FROM AUTHOR]

Objectives: To stratify psoriatic arthritis (PsA) patients based on psoriasis (PsO) onset age: early onset psoriasis (EOP) vs. late onset psoriasis (LOP), and to assess if there are differences in disease characteristics, activity/function/impact of the disease, and comorbidity indices. Methods: Cross-sectional analysis of a longitudinal PsA cohort. Patients were stratified based on PsO onset age. Results: One hundred and sixty PsA patients were enrolled (84 in EOP and 76 in LOP group) in the study. EOP PsA patients seem to have an increased probability to have dactylitis rather than LOP ones, OR 9.64 (3.77–24.6). Comorbidity indices (Rheumatic Disease Comorbidity Index and Charlson Comorbidity Index) were higher in LOP PsA patients, but these data were not confirmed when adjusted by age and sex. There are also differences in the treatment regimen: EOP PsA patients were more frequently treated with anti-interleukin (IL) 17; instead, LOP patients were more frequently treated with non-steroid anti-inflammatory drugs and conventional synthetic disease-modifying anti-rheumatics drugs. There were no differences in the disease activity, function, or impact of the disease. Conclusions: There are some clinical and therapeutic differences in PsA patients linked to the PsO onset age, namely dactylitis in EOP. Other characteristics found were: a "comorbidities trend" in LOP patients and a more frequent use of anti-IL17 in EOP. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this ultrasound and anatomical study were: (1) To evaluate the reliability of ultrasound identification of the enthesis of the central slip of the extensor digitorum tendon (CSET) using cadaver specimens; (2) To assess the concordance of the measurement of the CSET thickness by ultrasound and gross anatomy; (3) To evaluate the variation in ultrasound identification of the CSET enthesis in a cadaveric experimental model of PIP synovitis., Methods: Four rheumatologist ultrasonographers blindly and independently measured by ultrasound the CSET enthesis thickness in the second to fifth fingers of 8 hands from fresh-frozen human cadavers in two rounds. These fingers were dissected and the thickness of the CSET measured by the anatomist. In addition, an artificial synovitis was created in the proximal interphalangeal (PIP) joints of a different cadaveric hand. The ultrasonographic CSET enthesis thickness was measured by the four investigators before and after intra-articular ultrasound guided injection of material., Results: Intra- and inter-observer reliability of CSET enthesis thickness measurement were good to excellent (ICC 0.93 for intra-observer agreement and 0.89-0.92 for inter-observer agreement). Ultrasound measurements were consistent and only slightly smaller than the anatomical ones (µ = -0.039 mm). The differences between the measurements of CSET enthesis thickness before and after the synovitis model were not statistically significant., Conclusion: Ultrasound demonstrated high multiobserver reliability and agreement with gross anatomy in identifying the CSET enthesis and discriminated it from the capsular tissue of the PIP. Furthermore, an experimental model of PIP synovitis did not interfere with its identification., Competing Interests: Conflict of interest None., (Copyright © 2024 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex., (© Japan College of Rheumatology 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)