Sakellariou Garifallia, Girolimetto Nicolò, Tinazzi Ilaria, Canzoni Marco, Filippou Georgios, Batticciotto Alberto, Possemato Niccolò, Macchioni Pierluigi, De Lucia Orazio, Dejaco Christian, Idolazzi Luca, Pirri Carmelo, Iagnocco Annamaria
Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy.
Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia, Italy.
Clin Rheumatol. 2025 May;44(5):1939-1947. doi: 10.1007/s10067-025-07395-y. Epub 2025 Mar 20.
Dactylitis is a hallmark of psoriatic arthritis (PsA). While its assessment is clinical, recently musculoskeletal ultrasonography (MSUS) has been applied to its monitoring. However, the evidence on MSUS application for toe dactylitis is limited. The aim of this study is to characterize the ultrasonographic features of toe dactylitis in PsA.
Patients with PsA and painful toe dactylitis were retrospectively identified from clinical records. Demographic and clinical variables were analyzed. Ultrasound images of the affected toe, allowing the assessment of grey scale (GS) and power Doppler (PD) were collected, to evaluate tenosynovitis, soft tissue oedema (STO), synovitis of metatarsophalangeal (MTP), proximal and distal interphalangeal (PIP, DIP) joints (all graded 0-3), and peritendonitis (PTI) at the MTP and PIP (graded 0-1). Clinical and ultrasonographic features were analyzed through descriptive statistics.
The study included 26 patients (30 toes) of which 9 (34.5%) females, with mean (sd) age of 46.8 (11.73). All but one patient had an oligoarticular phenotype. Tenosynovitis was the most frequent lesion, with GS abnormalities in 27/30 toes (90%) and PD in 25/30 (83.3%). STO was common (GS in 28/30 (93.33%) toes and PD in 20/30 (66.66%)). Synovitis was less common (63.33%, 46.66% and 33.33% of MTPs, PIPs and DIPs, respectively), while PTI was uncommon, with no patient presenting with PD.
Ultrasound showed different elementary lesions in toe dactylitis confirming the complexity of this manifestation also at foot. These findings represent a first step toward the development of further imaging studies assessing toe dactylitis in PsA. Key Points • Tenosynovitis and soft tissue oedema were the most common ultrasonographic elementary lesion in acute toe dactylitis in psoriatic arthritis. • Synovitis was less frequent and peritendonitis was very uncommon. • Musculoskeletal ultrasound confirms the presence of multiple lesions in painful toe dactylitis, confirming the complexity of this manifestation.
指（趾）炎是银屑病关节炎（PsA）的一个标志。虽然其评估是临床性的，但最近肌肉骨骼超声检查（MSUS）已被应用于其监测。然而，关于MSUS应用于趾指（趾）炎的证据有限。本研究的目的是描述PsA中趾指（趾）炎的超声特征。
从临床记录中回顾性识别出患有PsA和疼痛性趾指（趾）炎的患者。分析人口统计学和临床变量。收集患趾的超声图像，以评估灰阶（GS）和能量多普勒（PD），以评估腱鞘炎、软组织水肿（STO）、跖趾（MTP）关节、近端和远端指间（PIP、DIP）关节的滑膜炎（均分为0 - 3级）以及MTP和PIP处的腱周炎（PTI）（分为0 - 1级）。通过描述性统计分析临床和超声特征。
该研究纳入了26例患者（30个趾），其中9例（34.5%）为女性，平均（标准差）年龄为46.8（11.73）岁。除1例患者外，所有患者均为少关节型。腱鞘炎是最常见的病变，27/30个趾（90%）有GS异常，25/30个趾（83.3%）有PD异常。STO很常见（28/30个趾（93.33%）有GS异常，20/30个趾（66.66%）有PD异常）。滑膜炎较少见（MTP、PIP和DIP的滑膜炎分别为63.33%、46.66%和33.33%），而PTI不常见，没有患者出现PD异常。
超声显示趾指（趾）炎中有不同的基本病变，证实了这种表现形式在足部也很复杂。这些发现是进一步开展评估PsA中趾指（趾）炎的影像学研究的第一步。要点 • 腱鞘炎和软组织水肿是银屑病关节炎急性趾指（趾）炎中最常见的超声基本病变。 • 滑膜炎较少见，腱周炎非常罕见。 • 肌肉骨骼超声证实疼痛性趾指（趾）炎中存在多种病变，证实了这种表现形式的复杂性。
