Healy P J, Groves C, Chandramohan M, Helliwell P S
Academic Unit of Musculoskeletal Medicine, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK.
Rheumatology (Oxford). 2008 Jan;47(1):92-5. doi: 10.1093/rheumatology/kem315.
To quantify the extent of inflammation in psoriatic dactylitis and to examine the relationship between clinical and magnetic resonance imaging (MRI) data in both tender and non-tender dactylitis.
Seventeen patients with psoriatic dactylitis underwent clinical assessment for 6 months after change of treatment, usually to methotrexate. Measures of dactylitis included the Leeds Dactylitis Index, the assessment tool used in the Infliximab in Psoriatic Arthritis Clinical Trial (IMPACT), a simple count of tender dactlylitic digits and a count of all dactylitic digits, both tender and non-tender. MRI scans of the affected hand or foot were performed before and after treatment using a 1.5T Siemen's scanner pre- and post-contrast.
All patients improved clinically, as did their respective dactylitis scores and MRI images. The findings on MRI in both dactylitic and non-dactylitic digits were profound and widespread. The difference between tender and non-tender dactylitis was quantitative rather than qualitative. Synovitis and soft-tissue oedema were the most frequent abnormalities being present in 69% of tender dactylitic digits but bone oedema and flexor tenosynovitis were also frequently seen. Soft-tissue oedema was circumferential and enhancing and not limited to association with the flexor or extensor tendons. None of the clinical indices of dactylitis showed a close relationship to the extent of MRI abnormalities.
MRI images demonstrate widespread abnormalities in digits of people with psoriatic arthritis. Tender dactylitic digits have more abnormalities than other digits but the relationship between clinical and MRI scores is not strong.
量化银屑病性指（趾）炎的炎症程度，并研究压痛性和非压痛性指（趾）炎的临床与磁共振成像（MRI）数据之间的关系。
17例银屑病性指（趾）炎患者在改变治疗方案（通常为甲氨蝶呤）后接受了6个月的临床评估。指（趾）炎的评估指标包括利兹指（趾）炎指数、银屑病关节炎临床试验（IMPACT）中使用的评估工具、压痛性指（趾）炎指（趾）数的简单计数以及所有指（趾）炎指（趾）数（包括压痛性和非压痛性）的计数。使用1.5T西门子扫描仪在治疗前后对患手或患足进行MRI扫描，扫描前和扫描后均进行对比。
所有患者的临床症状均有改善，其各自的指（趾）炎评分和MRI图像也有所改善。指（趾）炎和非指（趾）炎指（趾）的MRI表现均显著且广泛。压痛性和非压痛性指（趾）炎之间的差异是定量的而非定性的。滑膜炎和软组织水肿是最常见的异常，在69%的压痛性指（趾）炎指（趾）中出现，但骨水肿和屈肌腱腱鞘炎也很常见。软组织水肿呈环形且有强化，并不局限于与屈肌腱或伸肌腱相关。指（趾）炎的临床指标均未显示与MRI异常程度有密切关系。
MRI图像显示银屑病关节炎患者的指（趾）存在广泛异常。压痛性指（趾）炎指（趾）比其他指（趾）有更多异常，但临床评分与MRI评分之间的关系并不密切。
