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Review
. 2021 Aug 28:13:1759720X211041864.
doi: 10.1177/1759720X211041864. eCollection 2021.

Corticosteroid injection treatment for dactylitis in psoriatic arthritis

Antonio Carriero  1 , Ennio Lubrano  2 , Valentina Picerno  3 , Angela Anna Padula  3 , Salvatore D'Angelo  3
Affiliations
Review

Corticosteroid injection treatment for dactylitis in psoriatic arthritis

Antonio Carriero et al. Ther Adv Musculoskelet Dis. .

Abstract

Dactylitis - a hallmark clinical feature of psoriatic arthritis (PsA) - that occurs in 30-50% of PsA patients, is a marker of disease severity for PsA progression, an independent predictor of cardiovascular morbidity and impairs the motor functions of PsA patients. There is a paucity of evidence for the treatment due to the absence of randomized controlled trials assessing dactylitis as a primary endpoint and current practice arises from the analysis of dactylitis as a secondary outcome. Corticosteroid (CS) injections for dactylitis in PsA patients are a therapeutic treatment option for patients with isolated dactylitis or for patients with flares in tendon sheaths, despite stable and effective systemic treatment. The aim of this narrative review is to briefly illustrate the clinical aspects of dactylitis in PsA, the imaging and clinimetric tools used to diagnose and monitor dactylitis, the current treatment strategies and principally to provide a comprehensive picture of the clinical efficacy and safety with ultrasound-guide and blind techniques of CS injections for dactylitis in PsA patients.

Keywords: corticosteroid; dactylitis; injection; psoriatic arthritis; tenosynovitis; therapy; treatment; ultrasound.

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Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Dactylitis of the second digit of the right hand (frontal view). (b) Dactylitis of the second digit of the right hand compared to the contralateral (lateral view).
Figure 2.
Figure 2.
Tenosynovitis of the III right flexor tendon characterized by marked synovial proliferation, a moderate increase of the tendon thickness and a thickened and hypoecoic peritendineal tissue. Synovial sheath widening (circle) associated with soft-tissue edema (asterisk). Power Doppler function revealed diffuse and severe vascular signal inside and around the tendon sheath (Grade 3). DP, distal phalanx; FT, flexor tendon; MP, medial phalanx.
Figure 3.
Figure 3.
US follow-up after 4 weeks of the same tendon. Note the dramatic reduction of the power Doppler signal (Grade 0) and gray scale score (Grade 0) with the resolution of the flexor tenosynovitis and the soft-tissue edema.
Figure 4.
Figure 4.
Blind corticosteroid injection for PsA dactylitis.
Figure 5.
Figure 5.
US-guided corticosteroid injection for PsA dactylitis.
See this image and copyright information in PMC

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