Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia.
Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples.
Rheumatology (Oxford). 2021 Sep 1;60(9):4103-4111. doi: 10.1093/rheumatology/keaa885.
The aim of the study is to assess the performance of the DACTOS (DACtylitis glObal Sonographic) score in a 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.
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, 1 month (T1) and 3 months (T3).
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).
The DACTOS score performs well in real-life clinical settings in terms of sensitivity to change and correlations with clinical features in PsA dactylitis.
本研究旨在评估 DACTOS（掌指关节炎全球超声）评分在 PSA 关节炎患者出现指关节炎时的表现。特别地，我们评估了 DACTOS 识别受累手指的能力、治疗后变化的敏感性、DACTOS 与临床参数之间的相关性，以及评分识别治疗反应者的能力。
本观察性前瞻性研究纳入了 46 例有症状的 PSA 关节炎手部关节炎患者。在这项研究中，73 个受累的指关节炎在治疗前后均进行了临床和超声评估。临床评估包括利兹指关节炎基本指数（LDI-b）评分和疼痛视觉模拟量表（VAS-p）和功能障碍视觉模拟量表（VAS-FI）。超声检查采用高频超声，根据 DACTOS 评分评估灰阶和能量多普勒特征的超声病变。在基线、1 个月（T1）和 3 个月（T3）评估时，评估 DACTOS 评分与临床参数之间的相关性。
我们观察到在治疗指关节炎后，所有评估的临床参数和 DACTOS 评分均有显著改善。在 T1 和 T3 评估时，所有临床参数（VAS-p、VAS-FI 和 LDI-b）的变化与 DACTOS 评分之间均存在统计学显著相关性。我们发现，在 DACTOS 评分方面，临床反应者和非反应者组之间（P<0.001）以及临床缓解者和非缓解者组之间（P<0.001）存在统计学显著差异。
在 PSA 关节炎患者出现指关节炎的临床环境中，DACTOS 评分在变化的敏感性和与临床特征的相关性方面表现良好。
