CLINICAL AND MAGNETIC RESONANCE IMAGING ASSESSMENT IN EARLY PSORIATIC ARTHRITIS

I. Troshkina, V. Badokin, S. Krasnenko Russia Medical Academy of Post-Graduate Training, Moscow, Russian Federation

Background: Dactylitis or "sausage-like" digits are characteristic for psoriatic arthritis (PsA) and can be the only manifestations of the early stage of this disease.

Objectives: To determine clinical importance of dactylitis in early PsA.

Methods: 46 patients (27 women, 16 men) with early PsA with mean disease duration of 11.5±6.7 months. Age of patients was from 19 to 72 yrs (mean age 43±13.8 yrs). Mean psoriasis duration was 8 yrs. Oligoarticular variant of articular syndrome was found in 23 patients, polyarticular – in 21, spondyloarthrirtic – in 2. Clinically dactylitis were found in 24 (52.2%) patients, including dactylitis fingers – in 10 (21.7%) and toes in 19 (41.3%). Multiple dactylitis were found in 13 (28.3%) patients. The 1st group (experimental) included 24 patients with dactylitis and the 2ndgroup (control) – 22 without dactylitis. Dactylitis with duration of 3 months were considered acute, and with more duration – chronic. C-reactive protein was determined by highly sensitive method (hsCRP). Elevated levels of hsCRP and erythrocyte sedimentation rate (ESR) were found in 29 (63%) and – in 25 (53.4%) of examined patients, accordingly. Mean index DAS28 in the 1stgroup was equal to 4.03±1.6 and in the 2ndgroup – 5.3±1.4. All patientswere underwent magnetic resonance imaging (MRI) by the apparatus 0.2 T Artoscan C.

Results: The 1st group of patients with dactylitis demonstrated digits edema with "sausage-like" disfiguration. According to MRI tenosynovitis were found in 18 (75%) of 24 patients, synovitis – in 21 (87.5%), edema of bone marrow – in 3 (12.5%), edema of soft tissue – in 4 (16.7%), erosions – in 3(12.5%), cysts – in 6 (25%). In control group without edema of hands and feet digits, tenosynovitis were found in 9 (41%) of 22 patients, synovitis – in 17(77.3%), bone marrow edema – in 4 (18.2%), soft tissue edema – in 2 (9%), erosions – in 3 (13.6%), cysts – in 5 (22.7%). In the 1st group as compared with the 2nd tenosynovitis were found significantly more often (p<0.003). On studying 18 acute dactylitis, isolated tenosynovitis were found in 7 (38.9%) cases, tenosynovitis accompanied by synovitis – in 5(28.7%), only synovitis – in 4 (22%) and in 2 (11%) cases with diffuse digits edema had no MRI symptoms. Among 44 chronic dactylitis in 25 (56.8%) cases tenosynovitis were accompanied by synovitis, in 9(20.5%) – only synovitis and in 10 (22.7%) – pathologies were not found. In this group there were no isolated tenosynovitis. Analyzing dactylitis depending on the duration of their course, in turned out, that during the first 3 months mainly synovitis were determined (p<0.04). Association of dactylitis was found with elevated ESR level (p<0.02) and high degree of the disease activity (DAS28>5.1) (p<0.02), but not with concentration of hsCRP.

Conclusion: Dactylitis as characteristic symptom of PsA, could be found already during the early stage of the disease in high percentage (52.2%). In the onset of this disease isolated tenosynovitis are characteristic. During the forming of diffuse edema of the fingers and toes tenosynovitis are of greater importance while during later stages the process includes synovial sheath. Psoriatic dactylitis are associated with higher degree of inflammatory activity of the disease.

Disclosure of Interest: None declared

Citation: Ann Rheum Dis 2010;69(Suppl3):586

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