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

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Abstract

Objectives

To explore the frequency 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 finger or toe was performed using greyscale and color Doppler mode. One examiner scanned all patients and a second examiner scanned 10 patients for inter-reader reliability. For each digit, the following lesions were evaluated: subcutaneous edema; soft tissue thickening; synovitis of the digital joints; tenosynovitis of the flexor tendon; enthesitis at the deep flexor 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 flexor tenosynovitis (52%). Color Doppler was most frequently found subcutaneously (55%) and around the flexor tendons (45%). All lesions were typically found in combinations, most commonly subcutaneous edema and synovitis (71%), subcutaneous edema and flexor tenosynovitis (52%), and all three in combination (52%). Tender digits had a higher dactylitis sum-score 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 lesions, most often subcutaneous changes combined with synovitis and/or flexor tenosynovitis. Reliability of scoring established ultrasound lesions of dactylitis in a clinical setting is moderate-excellent.

Key Points

• Dactylitis in psoriatic arthritis consists of multiple ultrasound lesions

• A dactylitis ultrasound sum-score gives an impression of severity by including all lesions

• Reliability of ultrasound scoring of dactylitis components is good

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Fig. 1
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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank all participating patients as well as staff at Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup and The Danish Rheumatism Association and the Danish Psoriasis Association for financial support.

Funding

This work was supported by research funds from The Danish Rheumatism Association and the Danish Psoriasis Association. The funding body did not play any role in the design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark

    Sara K. Felbo, Mikkel Østergaard, Inge J. Sørensen & Lene Terslev

  2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Sara K. Felbo, Mikkel Østergaard & Lene Terslev

Authors
  1. Sara K. Felbo
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  2. Mikkel Østergaard
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  3. Inge J. Sørensen
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  4. Lene Terslev
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Contributions

All authors designed the study and developed the study protocol. SKF and LT performed the ultrasound examinations and scoring as described. SKF performed analyses and wrote the first draft of the paper. All authors interpreted data, revised the manuscript, read, and approved the final manuscript.

Corresponding author

Correspondence to Sara K. Felbo.

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Ethics approval

The ethics committee of the capital region in Denmark approved the research protocol (journal no. H-16035123).

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Informed consent was obtained from all subjects prior to inclusion.

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Patients consent to publication.

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Felbo, S.K., Østergaard, M., Sørensen, I.J. et al. Which ultrasound lesions contribute to dactylitis in psoriatic arthritis and their reliability in a clinical setting. Clin Rheumatol 40, 1061–1067 (2021). https://doi.org/10.1007/s10067-020-05483-9

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  • DOI: https://doi.org/10.1007/s10067-020-05483-9

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