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. 2024 Jan 18;11(3):S298-S304.
doi: 10.5152/eurjrheum.2024.21096.

Ultrasound in the Evaluation of Dactylitis and Enthesitis in Psoriatic Arthritis

Ana Urruticoechea-Arana  1 , Mireia Moreno  2 , Manuel Pujol  3 , Teresa Clavaguera  4
Affiliations

Ultrasound in the Evaluation of Dactylitis and Enthesitis in Psoriatic Arthritis

Ana Urruticoechea-Arana et al. Eur J Rheumatol. .

Abstract

Dactylitis is a clinical concept that corresponds to the swelling of the whole finger or toe giving a sausage appearance. Although it can be observed in different diseases, it is a distinctive clinical feature of psoriatic arthritis and is associated with a poor prognosis. Ultrasound has made it possible to improve our understanding of the pathogenesis of psoriatic arthritis dactylitis, identifying associated structural alterations, namely, flexor tenosynovitis, subcutaneous tissue edema, pulley inflammation with thickening and intra-pulley Doppler signals, extensor paratenonitis, synovitis, pericapsular bone formation, and flexor enthesitis. Given its complexity, a consensus has yet to be reached on an ultrasound-based definition of dactylitis. In addition, enthesitis is one of the characteristic features of spondyloartritis. Enthesitis, like dactylitis, is among the clinical manifestations in the Assessment of SpondyloArthritis international Society classification criteria for both axial and peripheral spondyloartritis and is a key feature for classifying psoriatic arthritis with the Classification criteria for Psoriatic Arthritis criteria. Ultrasonography is a very useful tool for exploring the enthesis. We have a good sonographic definition, although ultrasound findings do not always allow us to differentiate between mechanical or inflammatory lesions. Elementary lesions that characterize enthesopathy are hypoechogenicity at the enthesis, thickened enthesis, calcification/enthesophyte at enthesis, erosion at enthesis, and Doppler signal at enthesis. Different composite indices have been proposed in order to classify spond yloarthropathies. This article reviews the evaluation of dactylitis and enthesitis from the sonographic perspective.

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Conflict of interest statement

Declaration of Interests: The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Dactylitis of the second and fourth toe and onycopathy.
Figure 2.
Figure 2.
Ultrasound longitudinal view of the second flexor of the toe fluid and synovial thickening within the tendon sheath. There is power Doppler signal inside the sheath and surrounding the soft tissue.
Figure 3.
Figure 3.
Ultrasound transversal view demonstrates tenosynovitis with power Doppler signal inside the tendon sheath and the surroundings.
Figure 4.
Figure 4.
Flexor tendon of the second finger, longitudinal section: centered on the region next to IFP. Gray scale with tenosynovitis without proximal interphalangeal joint (IFP) arthritis.
Figure 5.
Figure 5.
Flexor tendon of the second finger, longitudinal section: centered on the region next to IFP. Doppler signal located peritendinous and subcutaneous cellulose tissue.
Figure 6.
Figure 6.
Flexor tendon of the second finger longitudinal section, centered on the proximal region, adjacent to MCF. Gray scale with tenosynovitis without arthritis of metacarpophalangeal joint (MCF).
Figure 7.
Figure 7.
Flexor tendon of the second finger longitudinal section, centered on the proximal region, adjacent to MCF. Doppler signal localized peritendinous and in subcutaneous cellulose tissue.
Figure 8.
Figure 8.
Achilles tendon. Cortical with distal enthesophyte irregularities and erosions.
Figure 9.
Figure 9.
Achilles tendon with cortical and tendon Doppler signal.
See this image and copyright information in PMC

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