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Psoriatic Arthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Elena Ciofoaia, Ana-Maria Orbai, Jason Liebowitz
Dactylitis is not just a consequence of flexor tenosynovitis and articular synovitis, but is also associated with radiologically evident erosive damage to joints. Dactylitis affects the whole finger with equal severity and there is no preference for damage to a particular small joint in an affected digit (Brockbank et al., 2005). The presence of articular synovitis on ultrasonography in a dactylitic finger correlates with the presence of joint space narrowing and periostitis on plain radiography (Kane, 1999).
Diagnosing Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
The location of dermatologic disease can also be an important determinant of the degree of disability that it causes. Although the severity of most dermatologic conditions is correlated with the body surface area of involvement, even small and localized lesions on the palms and soles can be debilitating given their functional importance. For example, patients with dactylitis in psoriasis and psoriatic arthritis may be unable to work with their hands as effectively, if at all. Plantar warts and clavus can likewise cause discomfort during ambulation, which can limit mobility. Diseases, such as atopic dermatitis, can also cause fissuring around joints, which can result in discomfort with movement and subsequent immobilization.
The locomotor system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Tuberculous arthritis results from haematogenous spread of infection to the synovium or by extension from an affected intracapsular portion of bone. The hip and knee are most commonly involved. Inflammation of the synovium extends to involve the subchondral bone and dissects it from the articular cartilage, leading to destruction of the joint surface. Less commonly, bone involvement occurs in the absence of joint disease, typically with destructive lesions in the metaphysis of long bones, e.g. the knee, femoral neck, and greater trochanter. The tubular bones of the hands may be affected (dactylitis).
Tailored biological treatment for patients with moderate-to-severe psoriasis
Published in Expert Review of Clinical Immunology, 2023
Martina Maurelli, Paolo Gisondi, Giampiero Girolomoni
PsA is the major comorbidity associated with psoriasis characterized by the involvement of different musculoskeletal domains. The prevalence of PsA is around one-third of Caucasian patients with psoriasis, ranging between 6% and 42%, and is highest among patients between 30 and 60 years. The majority of patients first develop psoriasis and only later develop PsA by a median of 8 years, although in 15% of cases, PsA and psoriasis occur simultaneously or PsA precedes cutaneous disease. In many cases, PsA is a mild-to-moderate disease with a fluctuating course, but the risk of development of bone erosion with a disabling form of arthritis is high. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recognized different domains of PsA to suggest a more appropriate treatment to reach the lowest disease activity in each domain. These include peripheral arthritis, axial disease, enthesitis, dactylitis, skin disease, and nail disease. Enthesitis can be found in 30–50% of patients and affects generally the plantar fascia and Achilles’ tendon, causing pain around patella, iliac crest and epicondyles. Dactylitis is observed in 40–50% of patients, involving asymmetrically particularly the third and fourth toes, but also other toes and hands [8–11].
Inner Ear Complications in Children and Adolescents with Sickle Cell Disease
Published in Hemoglobin, 2020
Azza A.G. Tantawy, Safaa W. Ibrahim, Togan T. Abdel-Aziz, Amr N. Rabie, Sara M. Makkeyah, Iman A. Ragab
The membranous labyrinth is supplied by the labyrinthine artery that either arises from the anterior inferior cerebellar artery or as a direct branch of the BA. Whether the flow velocity could be predictive of labyrinthine pathology remains to be answered; vaso-occlusion in patients with sickle cell disease can occur within any organ and the labyrinthine artery has a higher chance of vaso-occlusion due to its small caliber. It is of interest that two out the five patients with abnormal MRI findings had past history of frequent dactylitis in early life. Those two patients also had silent MRI ischemic foci, however, none of them had SNHL. A significant relationship between hearing loss and dactylitis in early childhood was previously reported by other investigators [7], however, they did not investigate the inner ear MRI findings in their study cohort.
Focussing on the foot in psoriatic arthritis: pathology and management options
Published in Expert Review of Clinical Immunology, 2018
Aimie Patience, Philip S. Helliwell, Heidi J. Siddle
Dactylitis, also known as ‘sausage’ digit, is a hallmark clinical feature of PsA and other spondyloarthropathies presenting as an acutely painful, uniformly swollen digit. Of the 39–48% of patients with PsA who have dactylitis, 75% of these cases occur in the foot [29,30]. Dactylitis can be an early indicator of PsA and forms part of the classification criteria for diagnosing PsA [31,32]. Similarly to enthesitis, the presence of dactylitis is a potential adverse prognostic factor and is associated with elevated disease activity, poorer functional status, and greater disease burden compared to those without dactylitis [21]. Dactylitis may be a marker for arthritis mutilans in which typical changes such as erosion of the terminal phalangeal tufts, juxta-articular and entheseal new bone formation, periostitis, and severe osteolysis are seen on plain radiography [33]. MRI may show inflammation in several tissues, including tenosynovitis, synovitis, enthesitis, and bone edema. The European League Against Rheumatism (EULAR) and GRAPPA recognize the significance of dactylitis and recommend the use of biologics for patients with active dactylitis (and/or enthesitis) who do not respond to NSAIDs or local corticosteroid injections [27,34].