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Ignazio Olivieri - One of the best experts on this subject based on the ideXlab platform.
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Dactylitis
Oxford Medicine Online, 2018Co-Authors: Ignazio Olivieri, Enrico Scarano, Salvatore D’angelo, Carlo Palazzi, Angela PadulaAbstract:This chapter covers Dactylitis, or ‘sausage-shaped’ digits. As the types of Dactylitis depends on the tissues involved and the type of involvement, ‘false’ Dactylitis is discussed, and the manifestation of diffuse swelling in spondyloarthritis (SpA) is differentiated from the other forms. Clinical aspects and imaging methods are described, followed by clinimetric assessment and the development of composite scores such as CPDAI and PASDAS. Finally, therapies are described.
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Ultrasound and magnetic resonance imaging in the evaluation of psoriatic Dactylitis: status and perspectives.
The Journal of rheumatology, 2013Co-Authors: Catherine J. Bakewell, Ignazio Olivieri, Sibel Zehra Aydin, Christian Dejaco, Kei Ikeda, Marwin Gutierrez, Lene Terslev, Ralf G. Thiele, Maria Antionetta D’agostino, Gurjit S. KaeleyAbstract:Objective. Dactylitis, a characteristic feature of the spondyloarthropathies, occurs in up to 48% of patients with psoriatic arthritis (PsA). No clear consensus on the underlying components and pathogenesis of Dactylitis exists in the literature. We undertook a systematic review of ultrasound (US) and magnetic resonance imaging (MRI) literature to better define imaging elements that contribute to the dactylitic digit seen in PsA. Our objectives were to determine first the level of homogeneity of each imaging modality’s definition of the components of Dactylitis, and second, to evaluate the metric properties of each imaging modality according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) filter. Methods. Searches were performed in PUBMED and EMBASE for articles pertaining to MRI, US, and Dactylitis. Data regarding the reported features of Dactylitis were collected and categorized, and the metrological qualities of the studies were assessed. Results. The most commonly described features of Dactylitis were flexor tendon tenosynovitis and joint synovitis (90%). Extratendinous soft tissue thickening and extensor tendonitis were described nearly equally as being present and absent. Discrepancy exists as to whether entheses proper contribute to the etiology of Dactylitis. An increasing number of studies categorize abnormalities in several tissue compartments including the soft tissue, tendon sheaths, and joints, as well as ligaments. Conclusion. The understanding of which tissues contribute to dactylitic inflammation has evolved. However, there is a lack of literature regarding the natural history of these abnormalities. This systematic review provides guidance in defining elementary lesions that may discriminate dactylitic digits from normal digits, leading to development of a composite measure of activity and severity of Dactylitis.
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fast spin echo t2 weighted sequences with fat saturation in toe Dactylitis of spondyloarthritis
Clinical Rheumatology, 2008Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Salvatore Dangelo, Libero BarozziAbstract:We aimed to establish by using fast spin echo (FSE)-T2-weighted sequences with fat saturation if flexor tendon enthesitis is the primary lesion in spondyloarthritis (SpA) toe Dactylitis. Consecutive patients showing toe Dactylitis and meeting Amor criteria for the classification of SpA were enrolled. Dactylitic toes and their corresponding normal contralateral digits were studied by FSE-T2-weighted sequences with fat saturation. Twelve dactylitic toes belonging to ten SpA patients were studied. All dactylitic toes showed mild-to-moderate fluid collection in the synovial sheaths of flexor digitorum brevis and longus. Involvement of joint cavity was simultaneously seen in at least one joint of eight (66.6%) out of the 12 toes. A mild-to-severe peritendinous soft tissue edema was observed in all but one of the affected toes. In no dactylitic toe was bone edema observed either near the insertions of the flexor digitorum brevis and longus tendons or in other sites of the phalanges. No lesions were observed in the 12 contralateral clinically normal toes. In SpA toe Dactylitis there is no evidence of enthesitis of the flexor digitorum brevis and longus tendons and joint capsules.
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Dactylitis, a term for different digit diseases.
Scandinavian journal of rheumatology, 2006Co-Authors: Ignazio Olivieri, Angela Padula, Enrico Scarano, V. Giasi, F PrioloAbstract:Dorland's Illustrated Medical Dictionary gives the following definition of Dactylitis (deltaalphachitauupsilonlambdaomicronsigma = digit): 'inflammation of a finger or toe'. Although any inflammatory process involving the fingers or toes may be called Dactylitis, the term has entered in current use only in some well-defined entities. These differ in the involved tissue of the digit and in the type of involvement. Tuberculous Dactylitis is the variant of tuberculous osteomyelitis affecting the short tubular bone of the hands and feet. Radiographs typically show a central, lytic, cystic, and expansive lesion known as spina ventosa. Syphilitic Dactylitis is a manifestation of congenital syphilis. Radiological findings mimic those of tuberculous Dactylitis but the involvement is bilateral and symmetric. Sarcoid Dactylitis is due to typical non-caseating granulomas invading the phalanges and the adjacent soft tissue. Blistering distal Dactylitis is an infection of the anterior fat pad on the volar surface of the distal portion of a single finger or more rarely a toe, mostly caused by group A beta-haemolytic streptococci. Sickle cell Dactylitis, also known as 'hand-foot syndrome', is due to localized bone marrow infarction of the carpal and tarsal bones and phalanges. Spondyloarthritis Dactylitis, also called 'sausage-like' digit, is a diffuse painful swelling of the fingers and toes. Recent ultrasonography (US) and magnetic resonance imaging (MRI) studies on both finger and toe Dactylitis have established that Dactylitis is due to flexor tenosynovitis and that the enlargement of the joint capsule is not an indispensable condition for the 'sausage-like' feature. There is no evidence of enthesitis of flexor digitorum tendons and joint capsule.
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fast spin echo t2 weighted sequences with fat saturation in Dactylitis of spondylarthritis no evidence of entheseal involvement of the flexor digitorum tendons
Arthritis & Rheumatism, 2002Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Giovanni Ciancio, Libero BarozziAbstract:Objective To establish by means of fast spin echo (FSE)–T2-weighted sequences with fat saturation if enthesitis of the flexor digitorum superficialis and profundus tendons is the primary lesion in spondylarthritis (SpA) finger Dactylitis. Methods Eleven dactylitic fingers and their corresponding normal, contralateral fingers, belonging to 6 patients who met the Amor criteria for SpA, were studied by FSE–T2-weighted sequences with fat saturation. Results All dactylitic fingers showed moderate or severe fluid collection in the flexor tendon synovial sheaths. Involvement of the joint cavity was simultaneously present in at least one joint in 3 (27.3%) of the 11 fingers. A mild to moderate peritendinous soft tissue edema was observed in 5 (45.5%) of the 11 affected fingers. In no dactylitic finger was bone edema observed near the insertions of the flexor digitorum superficialis or profundus tendons or in other sites of the phalanges. No lesions were observed in the 11 contralateral, clinically normal fingers. Conclusion In SpA Dactylitis there is no evidence of enthesitis of the flexor digitorum tendons and joint capsules.
Pierluigi Macchioni - One of the best experts on this subject based on the ideXlab platform.
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musculoskeletal ultrasound in monitoring clinical response to treatment in acute symptomatic psoriatic Dactylitis results from a multicentre prospective observational study
Journal of Clinical Medicine, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Rosario Peluso, Vittoria Bascherini, Antonio Marchetta, Niccolò Possemato, Giorgia Citriniti, Rebecca Mcconnell, Vincenzo SabbatinoAbstract: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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THU0372 EFFECTIVENESS OF STEROID INJECTION FOR HAND PSORIATIC Dactylitis: RESULTS FROM A MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY.
Annals of the Rheumatic Diseases, 2020Co-Authors: Nicolò Girolimetto, Ilaria Tinazzi, Giorgia Citriniti, Pierluigi MacchioniAbstract:Background: Dactylitis is a common feature of PsA, occurring in 16 to 49% of PsA patients, mostly in early disease. Objectives: To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath for the treatment of active Dactylitis in PsA patients as compared to systemic treatment (ST) alone. Methods: 73 hand Dactylitis were assessed in a prospective observational study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for pain (VAS pain), functional impairment (VAS-FI). In accordance with EULAR and GRAPPA recommendations, steroid injection was proposed to all patients. Patients who refused LT were treated with oral NSAIDs. The patients of the two groups continued baseline therapy with csDMARDs or corticosteroids. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3) by assessors blinded to this study. Results: The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group as compared to the ST group, both at T1 (p Conclusion: For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects and symptoms of hand psoriatic Dactylitis. References: [1]Gladman DD, Ziouzina O, Thavaneswaran A, Chandran V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J Rheumatol. 2013;40:1357-9. Disclosure of Interests: None declared
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effectiveness of steroid injection for hand psoriatic Dactylitis results from a multicentre prospective observational study
Clinical Rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Marco Tasso, Vittoria Bascherini, Antonio Marchetta, Niccolò Possemato, Giorgia Citriniti, Federica Martinis, Rosario PelusoAbstract:To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath of Dactylitis in psoriatic arthritis (PsA) patients as compared with systemic treatment (ST). Forty-six PsA patients with a total of 73 dactylitic fingers were assessed in an observational, multicentre, prospective study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for local pain (visual analogue scale-VAS pain) and functional impairment (VAS-FI). Steroid injection was proposed to all patients. Patients refusing LT were treated with oral NSAIDs. Both the groups continued baseline csDMARDs and/or corticosteroids therapy. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3). The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group (24 patients, 38 dactylitic fingers) as compared with the ST group (22 patients, 35 dactylitic fingers), both at T1 (p < 0.001, p < 0.001 and p = 0.008, respectively) and at T3 (p < 0.001, p < 0.001 and p < 0.001, respectively). A clinically meaningful treatment response (defined as a contemporary reduction of at least 5 points in VAS-pain and VAS-FI or as values of VAS-pain and VAS-FI were both ≤ 2) was observed at T1 in 33 (87%) digits in LT group and in 6 (17%) digits in ST group (p < 0.001). At T3, clinical response improved significantly in both the groups, with significant difference (94% vs 31%, p < 0.001). For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects of hand psoriatic Dactylitis.
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Association between Leeds Dactylitis Index and ultrasonographic features: a multicentre study on psoriatic hand Dactylitis.
Clinical and experimental rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Luisa Costa, Rosario Peluso, Marco Tasso, Antonio Marchetta, Niccolò Possemato, Paolo Bottiglieri, Carlo SalvaraniAbstract:OBJECTIVES The aim of this study was to explore the link between specific sonographic findings and Leeds Dactylitis Index basic (LDI-b) score in psoriatic arthritis (PsA) patients with hand Dactylitis. METHODS Ninety-one hand Dactylitis were evaluated in a multicentre study for the presence of pain, functional limitation and tenderness (2-point scale) and LDI-b score. Dactylitic fingers were investigated using high-frequency US in grey scale (GS) and power Doppler (PD). According to median LDI-b score value of 12, fingers were then divided into two groups and categorised into quartiles on the basis of the value of ratio of circumference. RESULTS Dactylitic fingers with a LDI-b score >12 showed a significantly higher prevalence of GS flexor tenosynovitis (p=0.015), PD flexor tenosynovitis (p=0.001) and soft tissue oedema (p=0.004), when compared with those with those with LDI-b score
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association between leeds Dactylitis index and ultrasonographic features a multicentre study on psoriatic hand Dactylitis
Clinical and Experimental Rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Luisa Costa, Rosario Peluso, Marco Tasso, Antonio Marchetta, Niccolò Possemato, Paolo Bottiglieri, Carlo SalvaraniAbstract:OBJECTIVES The aim of this study was to explore the link between specific sonographic findings and Leeds Dactylitis Index basic (LDI-b) score in psoriatic arthritis (PsA) patients with hand Dactylitis. METHODS Ninety-one hand Dactylitis were evaluated in a multicentre study for the presence of pain, functional limitation and tenderness (2-point scale) and LDI-b score. Dactylitic fingers were investigated using high-frequency US in grey scale (GS) and power Doppler (PD). According to median LDI-b score value of 12, fingers were then divided into two groups and categorised into quartiles on the basis of the value of ratio of circumference. RESULTS Dactylitic fingers with a LDI-b score >12 showed a significantly higher prevalence of GS flexor tenosynovitis (p=0.015), PD flexor tenosynovitis (p=0.001) and soft tissue oedema (p=0.004), when compared with those with those with LDI-b score <12. GS synovitis at proximal interphalangeal (PIP) level (p=0.003) showed more frequent in dactylitic fingers with a LDI-b score <12, than those with a higher LDI-b value. Fingers in the fourth quartile showed a significantly higher prevalence of GS flexor tenosynovitis of grade ≥2 (p=0.046) and joint synovitis of grade ≥2 at PIP level (p=0.028). CONCLUSIONS We found that high values of LDI are associated with US flexor tenosynovitis and soft tissue oedema in PsA Dactylitis. Results suggest a potential role of PIP joint synovitis in the genesis of hand digital swelling and of extra-articular structures alterations in determining the LDI score.
Nicolò Girolimetto - One of the best experts on this subject based on the ideXlab platform.
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Sensitivity to change and clinical correlations of the novel Dactylitis glObal Sonographic (DACTOS) score in psoriatic arthritis.
Rheumatology (Oxford England), 2020Co-Authors: Nicolò Girolimetto, Ilaria Tinazzi, Luisa Costa, Niccolò Possemato, Giorgia Citriniti, Alen Zabotti, Alberto Batticciotto, Marco Canzoni, Orazio De Lucia, F. FigusAbstract:OBJECTIVE The aim of the study is to assess the performance of the DACTOS (Dactylitis glObal Sonographic) score in a psoriatic arthritis (PsA) Dactylitis clinical setting. In particular, we evaluated the ability of DACTOS to identify the affected fingers, its sensitivity to change after treatment, the correlations between DACTOS and clinical parameters, and the capacity of the score to identify the treatment responders. METHODS Forty-six consecutive patients with symptomatic PsA hand Dactylitis were enrolled. A total of seventy-three dactylitic digits were evaluated clinically and sonographically before and after treatment in this observational and prospective study. Clinical assessment included the Leeds Dactylitis Index-basic (LDI-b) score and visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). Sonographic lesions were investigated using high-frequency ultrasound with grey scale and power Doppler features according to the DACTOS score. Correlations between the DACTOS score and the clinical parameters were assessed at baseline, one month (T1) and three months (T3). RESULTS We observed significant improvements in all of the assessed clinical parameters and the DACTOS scores after Dactylitis treatment. There was a statistically significant correlation between the variation of all clinical parameters (VAS-p, VAS-FI, and LDI-b) and the DACTOS score at T1 and T3 evaluations. We found statistically significant differences in the DACTOS score between clinical responder and non-responder groups (p< 0.001) and between clinical remission and non-remission groups (p< 0.001). CONCLUSION The DACTOS score performs well in real life, clinical settings in terms of sensitivity to change and correlations with clinical features in PsA Dactylitis.
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musculoskeletal ultrasound in monitoring clinical response to treatment in acute symptomatic psoriatic Dactylitis results from a multicentre prospective observational study
Journal of Clinical Medicine, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Rosario Peluso, Vittoria Bascherini, Antonio Marchetta, Niccolò Possemato, Giorgia Citriniti, Rebecca Mcconnell, Vincenzo SabbatinoAbstract: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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THU0372 EFFECTIVENESS OF STEROID INJECTION FOR HAND PSORIATIC Dactylitis: RESULTS FROM A MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY.
Annals of the Rheumatic Diseases, 2020Co-Authors: Nicolò Girolimetto, Ilaria Tinazzi, Giorgia Citriniti, Pierluigi MacchioniAbstract:Background: Dactylitis is a common feature of PsA, occurring in 16 to 49% of PsA patients, mostly in early disease. Objectives: To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath for the treatment of active Dactylitis in PsA patients as compared to systemic treatment (ST) alone. Methods: 73 hand Dactylitis were assessed in a prospective observational study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for pain (VAS pain), functional impairment (VAS-FI). In accordance with EULAR and GRAPPA recommendations, steroid injection was proposed to all patients. Patients who refused LT were treated with oral NSAIDs. The patients of the two groups continued baseline therapy with csDMARDs or corticosteroids. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3) by assessors blinded to this study. Results: The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group as compared to the ST group, both at T1 (p Conclusion: For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects and symptoms of hand psoriatic Dactylitis. References: [1]Gladman DD, Ziouzina O, Thavaneswaran A, Chandran V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J Rheumatol. 2013;40:1357-9. Disclosure of Interests: None declared
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Novel and reliable Dactylitis glObal Sonographic (DACTOS) score in psoriatic arthritis
Annals of the rheumatic diseases, 2020Co-Authors: Alen Zabotti, Ilaria Tinazzi, Alberto Batticciotto, Marco Canzoni, Orazio De Lucia, F. Figus, Garifallia Sakellariou, Luca Idolazzi, Greta Carrara, Nicolò GirolimettoAbstract:Objectives Dactylitis is one of the most typical features of psoriatic arthritis (PsA), with a high lifetime prevalence and inclusion in PsA clinical indices. Musculoskeletal ultrasonography (Msk-US) can readily detect inflammatory involvement of finger anatomical structures particular to Dactylitis and monitor therapeutic effects. In this study, we aim to identify the characteristic lesions in PsA Dactylitis of the hands, assess the reliability of Msk-US in scoring those lesions and develop a Dactylitis glObal Sonographic (DACTOS) score. Methods After a systematic literature review on the use of Msk-US in PsA Dactylitis, 12 rheumatologists participated in a three-round Delphi procedure and consensus meeting to agree on the sonographic elementary lesions characterising Dactylitis and on the composition of a global sonographic score. Then, a web-based and a patient-based intra-rater and inter-rater reliability exercise was performed to assess those lesions included in the score. Results DACTOS score was obtained by summing the scores of each lesion selected in the Delphi survey: subcutaneous soft tissue oedema, flexor tenosynovitis, peritendon extensor inflammation and synovitis. The DACTOS score ranges from 0 to 25. In the reliability exercises, we obtained moderate-to-excellent agreement for the sonographic lesions included in the score. Conclusions The novel DACTOS score is a reliable measure to interpret the multiple characteristic sonographic features of Dactylitis. The DACTOS score provides a useful global analysis of Dactylitis of the hand and can represent a support to clinical diagnosis as well as a useful tool for the management and research in patients with PsA with Dactylitis.
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effectiveness of steroid injection for hand psoriatic Dactylitis results from a multicentre prospective observational study
Clinical Rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Marco Tasso, Vittoria Bascherini, Antonio Marchetta, Niccolò Possemato, Giorgia Citriniti, Federica Martinis, Rosario PelusoAbstract:To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath of Dactylitis in psoriatic arthritis (PsA) patients as compared with systemic treatment (ST). Forty-six PsA patients with a total of 73 dactylitic fingers were assessed in an observational, multicentre, prospective study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for local pain (visual analogue scale-VAS pain) and functional impairment (VAS-FI). Steroid injection was proposed to all patients. Patients refusing LT were treated with oral NSAIDs. Both the groups continued baseline csDMARDs and/or corticosteroids therapy. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3). The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group (24 patients, 38 dactylitic fingers) as compared with the ST group (22 patients, 35 dactylitic fingers), both at T1 (p < 0.001, p < 0.001 and p = 0.008, respectively) and at T3 (p < 0.001, p < 0.001 and p < 0.001, respectively). A clinically meaningful treatment response (defined as a contemporary reduction of at least 5 points in VAS-pain and VAS-FI or as values of VAS-pain and VAS-FI were both ≤ 2) was observed at T1 in 33 (87%) digits in LT group and in 6 (17%) digits in ST group (p < 0.001). At T3, clinical response improved significantly in both the groups, with significant difference (94% vs 31%, p < 0.001). For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects of hand psoriatic Dactylitis.
Carlo Salvarani - One of the best experts on this subject based on the ideXlab platform.
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Association between Leeds Dactylitis Index and ultrasonographic features: a multicentre study on psoriatic hand Dactylitis.
Clinical and experimental rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Luisa Costa, Rosario Peluso, Marco Tasso, Antonio Marchetta, Niccolò Possemato, Paolo Bottiglieri, Carlo SalvaraniAbstract:OBJECTIVES The aim of this study was to explore the link between specific sonographic findings and Leeds Dactylitis Index basic (LDI-b) score in psoriatic arthritis (PsA) patients with hand Dactylitis. METHODS Ninety-one hand Dactylitis were evaluated in a multicentre study for the presence of pain, functional limitation and tenderness (2-point scale) and LDI-b score. Dactylitic fingers were investigated using high-frequency US in grey scale (GS) and power Doppler (PD). According to median LDI-b score value of 12, fingers were then divided into two groups and categorised into quartiles on the basis of the value of ratio of circumference. RESULTS Dactylitic fingers with a LDI-b score >12 showed a significantly higher prevalence of GS flexor tenosynovitis (p=0.015), PD flexor tenosynovitis (p=0.001) and soft tissue oedema (p=0.004), when compared with those with those with LDI-b score
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association between leeds Dactylitis index and ultrasonographic features a multicentre study on psoriatic hand Dactylitis
Clinical and Experimental Rheumatology, 2020Co-Authors: Nicolò Girolimetto, Pierluigi Macchioni, Ilaria Tinazzi, Luisa Costa, Rosario Peluso, Marco Tasso, Antonio Marchetta, Niccolò Possemato, Paolo Bottiglieri, Carlo SalvaraniAbstract:OBJECTIVES The aim of this study was to explore the link between specific sonographic findings and Leeds Dactylitis Index basic (LDI-b) score in psoriatic arthritis (PsA) patients with hand Dactylitis. METHODS Ninety-one hand Dactylitis were evaluated in a multicentre study for the presence of pain, functional limitation and tenderness (2-point scale) and LDI-b score. Dactylitic fingers were investigated using high-frequency US in grey scale (GS) and power Doppler (PD). According to median LDI-b score value of 12, fingers were then divided into two groups and categorised into quartiles on the basis of the value of ratio of circumference. RESULTS Dactylitic fingers with a LDI-b score >12 showed a significantly higher prevalence of GS flexor tenosynovitis (p=0.015), PD flexor tenosynovitis (p=0.001) and soft tissue oedema (p=0.004), when compared with those with those with LDI-b score <12. GS synovitis at proximal interphalangeal (PIP) level (p=0.003) showed more frequent in dactylitic fingers with a LDI-b score <12, than those with a higher LDI-b value. Fingers in the fourth quartile showed a significantly higher prevalence of GS flexor tenosynovitis of grade ≥2 (p=0.046) and joint synovitis of grade ≥2 at PIP level (p=0.028). CONCLUSIONS We found that high values of LDI are associated with US flexor tenosynovitis and soft tissue oedema in PsA Dactylitis. Results suggest a potential role of PIP joint synovitis in the genesis of hand digital swelling and of extra-articular structures alterations in determining the LDI score.
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fast spin echo t2 weighted sequences with fat saturation in toe Dactylitis of spondyloarthritis
Clinical Rheumatology, 2008Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Salvatore Dangelo, Libero BarozziAbstract:We aimed to establish by using fast spin echo (FSE)-T2-weighted sequences with fat saturation if flexor tendon enthesitis is the primary lesion in spondyloarthritis (SpA) toe Dactylitis. Consecutive patients showing toe Dactylitis and meeting Amor criteria for the classification of SpA were enrolled. Dactylitic toes and their corresponding normal contralateral digits were studied by FSE-T2-weighted sequences with fat saturation. Twelve dactylitic toes belonging to ten SpA patients were studied. All dactylitic toes showed mild-to-moderate fluid collection in the synovial sheaths of flexor digitorum brevis and longus. Involvement of joint cavity was simultaneously seen in at least one joint of eight (66.6%) out of the 12 toes. A mild-to-severe peritendinous soft tissue edema was observed in all but one of the affected toes. In no dactylitic toe was bone edema observed either near the insertions of the flexor digitorum brevis and longus tendons or in other sites of the phalanges. No lesions were observed in the 12 contralateral clinically normal toes. In SpA toe Dactylitis there is no evidence of enthesitis of the flexor digitorum brevis and longus tendons and joint capsules.
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fast spin echo t2 weighted sequences with fat saturation in Dactylitis of spondylarthritis no evidence of entheseal involvement of the flexor digitorum tendons
Arthritis & Rheumatism, 2002Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Giovanni Ciancio, Libero BarozziAbstract:Objective To establish by means of fast spin echo (FSE)–T2-weighted sequences with fat saturation if enthesitis of the flexor digitorum superficialis and profundus tendons is the primary lesion in spondylarthritis (SpA) finger Dactylitis. Methods Eleven dactylitic fingers and their corresponding normal, contralateral fingers, belonging to 6 patients who met the Amor criteria for SpA, were studied by FSE–T2-weighted sequences with fat saturation. Results All dactylitic fingers showed moderate or severe fluid collection in the flexor tendon synovial sheaths. Involvement of the joint cavity was simultaneously present in at least one joint in 3 (27.3%) of the 11 fingers. A mild to moderate peritendinous soft tissue edema was observed in 5 (45.5%) of the 11 affected fingers. In no dactylitic finger was bone edema observed near the insertions of the flexor digitorum superficialis or profundus tendons or in other sites of the phalanges. No lesions were observed in the 11 contralateral, clinically normal fingers. Conclusion In SpA Dactylitis there is no evidence of enthesitis of the flexor digitorum tendons and joint capsules.
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isolated peripheral enthesitis and or Dactylitis a subset of psoriatic arthritis
The Journal of Rheumatology, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Pierluigi Macchioni, Laura Niccoli, Angela Padula, S Ferri, Italo PortioliAbstract:Objective. To identify isolated peripheral enthesitis and/or Dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients. Methods. We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, Dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group. Results. 14 patients (3.5%) presented isolated episodes of peripheral enthesitis and/or Dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71%) presented at least one episode of finger and/or toe Dactylitis. 5 of these 10 patients (50%) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57%). 3 of these 8 patients (37%) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe Dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4%) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of Dactylitis. The frequency of isolated Achilles tendinitis and/or Dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2%; p = 0.001). Conclusion. In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or Dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA.
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fast spin echo t2 weighted sequences with fat saturation in toe Dactylitis of spondyloarthritis
Clinical Rheumatology, 2008Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Salvatore Dangelo, Libero BarozziAbstract:We aimed to establish by using fast spin echo (FSE)-T2-weighted sequences with fat saturation if flexor tendon enthesitis is the primary lesion in spondyloarthritis (SpA) toe Dactylitis. Consecutive patients showing toe Dactylitis and meeting Amor criteria for the classification of SpA were enrolled. Dactylitic toes and their corresponding normal contralateral digits were studied by FSE-T2-weighted sequences with fat saturation. Twelve dactylitic toes belonging to ten SpA patients were studied. All dactylitic toes showed mild-to-moderate fluid collection in the synovial sheaths of flexor digitorum brevis and longus. Involvement of joint cavity was simultaneously seen in at least one joint of eight (66.6%) out of the 12 toes. A mild-to-severe peritendinous soft tissue edema was observed in all but one of the affected toes. In no dactylitic toe was bone edema observed either near the insertions of the flexor digitorum brevis and longus tendons or in other sites of the phalanges. No lesions were observed in the 12 contralateral clinically normal toes. In SpA toe Dactylitis there is no evidence of enthesitis of the flexor digitorum brevis and longus tendons and joint capsules.
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fast spin echo t2 weighted sequences with fat saturation in Dactylitis of spondylarthritis no evidence of entheseal involvement of the flexor digitorum tendons
Arthritis & Rheumatism, 2002Co-Authors: Ignazio Olivieri, Carlo Salvarani, Fabrizio Cantini, Laura Niccoli, Angela Padula, Enrico Scarano, Giovanni Ciancio, Libero BarozziAbstract:Objective To establish by means of fast spin echo (FSE)–T2-weighted sequences with fat saturation if enthesitis of the flexor digitorum superficialis and profundus tendons is the primary lesion in spondylarthritis (SpA) finger Dactylitis. Methods Eleven dactylitic fingers and their corresponding normal, contralateral fingers, belonging to 6 patients who met the Amor criteria for SpA, were studied by FSE–T2-weighted sequences with fat saturation. Results All dactylitic fingers showed moderate or severe fluid collection in the flexor tendon synovial sheaths. Involvement of the joint cavity was simultaneously present in at least one joint in 3 (27.3%) of the 11 fingers. A mild to moderate peritendinous soft tissue edema was observed in 5 (45.5%) of the 11 affected fingers. In no dactylitic finger was bone edema observed near the insertions of the flexor digitorum superficialis or profundus tendons or in other sites of the phalanges. No lesions were observed in the 11 contralateral, clinically normal fingers. Conclusion In SpA Dactylitis there is no evidence of enthesitis of the flexor digitorum tendons and joint capsules.
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toe Dactylitis in patients with spondyloarthropathy assessment by magnetic resonance imaging
The Journal of Rheumatology, 1997Co-Authors: I Olivieri, Angela Padula, Libero Barozzi, A Pierro, M De Matteis, Pietro PavlicaAbstract:Objective. To investigate using magnetic resonance imaging (MRI) the part played by flexor and extensor tenosynovitis and synovitis of the metatarsophalangeal (MTP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in producing the sausage-like aspect of spondyloarthropathy (SpA) toe Dactylitis. Methods. Twelve sausage-like toes and corresponding contralateral of 7 consecutive patients meeting Amor criteria for SpA were studied by MRI. Results. All dactylitie toes showed fluid collections in the flexor synovial sheaths on MRI. Due to the sheath distension the plantar bone to skin distance was significantly increased (p<0.05) in the dactylitic toes compared to normal contralateral toes. Peritendinous since these were significantly thicker (p < 0.05) in normal toes. Extensor synovial sheaths were involved in only 4 dactylitic toes Of the 36 joints of the 12 dactylitie toes only 2 MTP joints showed capsule distension, Considering MRI as the gold standard. examination showed 100% sensitivity and specificity for flexor sheath involvement but lacked sensivity for extensor synovial sheaths and showed a low specificity for joint capsule distension. Conclusion. Like finger Dactylitis, toe Dactylitis may also be due to tenosynovitis and synovitis of MTP. PIP, and DIP joint, may not be a required condition for sausage-shaped appeal aiiee. Extensor tenosynovitis may be present in addition to flexor tenosynovitis. Physical examination is a sufficient method for diagnosing toe Dactylitis.
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Toe Dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging.
The Journal of rheumatology, 1997Co-Authors: I Olivieri, Angela Padula, Libero Barozzi, A Pierro, M De Matteis, Pietro PavlicaAbstract:Objective. To investigate using magnetic resonance imaging (MRI) the part played by flexor and extensor tenosynovitis and synovitis of the metatarsophalangeal (MTP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in producing the sausage-like aspect of spondyloarthropathy (SpA) toe Dactylitis. Methods. Twelve sausage-like toes and corresponding contralateral of 7 consecutive patients meeting Amor criteria for SpA were studied by MRI. Results. All dactylitie toes showed fluid collections in the flexor synovial sheaths on MRI. Due to the sheath distension the plantar bone to skin distance was significantly increased (p
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Dactylitis in patients with seronegative spondylarthropathy assessment by ultrasonography and magnetic resonance imaging
Arthritis & Rheumatism, 1996Co-Authors: Ignazio Olivieri, Angela Padula, S Ferri, Libero Barozzi, A Pierro, M De Matteis, L Favaro, Claudio Borghi, Pietro PavlicaAbstract:Objective. To establish by means of ultrasound and magnetic resonance imaging (MRI) the role of tenosynovitis and arthritis in determining the “sausage-like” aspect of finger Dactylitis and to compare the results of the 2 examinations. Methods. Twelve dactylitic fingers and their corresponding normal contralateral fingers belonging to 10 patients who met the Amor criteria for the diagnosis of seronegative spondylarthropathy (SpA) were studied by ultrasonography and MRI. Results. MRI revealed a significant increase in the volar bone-to-skin distance in dactylitic fingers with respect to that of the normal contralateral fingers (P < 0.001). This increase was due to distension of the flexor synovial sheaths (P < 0.00001) by fluid collection. Peritendinous soft tissues were not involved, since these were found to be significantly thicker in the normal fingers (P < 0.05). Of the 36 joints of the 12 dactylitic fingers, only 1 showed capsule distension. Using MRI as the “gold standard,” ultrasonography showed a 100% sensitivity and specificity for flexor tenosynovitis, but lacked sensitivity for joint involvement because it failed to reveal joint capsule distension in the only joint involved. Similarly, physical examination showed a 100% sensitivity and specificity for flexor sheath involvement. Conclusion. Dactylitis is due to flexor tenosynovitis. Enlargement of the finger joint capsule is not an indispensable condition for the “sausage-like” feature. Physical examination is a sufficient method for the diagnosis of Dactylitis.
