Images highlighting manifestations of psoriatic arthritis
Psoriatic arthritis (PsA) is a type of psoriatic disease that affects around 30% of people with psoriasis, a skin condition characterised by red, scaly patches [1]. One of the most distinctive features of PsA is dactylitis, a condition that causes painful swelling in the fingers and toes, often resembling sausages [2].
Dactylitis is considered a hallmark manifestation of PsA, occurring as a result of inflammation of the flexor tendon sheaths, entheses (sites where tendons or ligaments attach to bone), and surrounding soft tissues in the fingers or toes [2]. The pathogenesis involves inflammatory changes in the entheses and tendon pulleys (fibrous bands that hold the tendons close to bone) [2]. High-resolution ultrasound studies have identified thickening and inflammation of these pulley structures in PsA patients with dactylitis, suggesting that biomechanical stress and a "deep Koebner" phenomenon (where mechanical stress triggers inflammation) contribute to the development of dactylitis in PsA [2].
Clinically, the presence of dactylitis is significant for diagnosis and disease activity assessment in PsA. It is often associated with joint swelling and pain and may indicate more severe disease [3]. Dactylitis helps differentiate PsA from other types of arthritis, as it is less common in conditions like rheumatoid arthritis [3].
Early treatment of PsA can prevent or slow its progression, reducing the risk of permanent joint damage and improving overall quality of life [1]. Treatment for nail psoriasis, a common symptom of PsA, depends on the severity of symptoms and may include long-term medications, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, weight management, natural or lifestyle approaches, and drugs for PsA [4].
It is important to note that while dactylitis is a key feature of PsA, psoriasis can appear on darker skin tones, but it may be more difficult to detect due to the skin's pigmentation [5]. Additionally, drugs for PsA can have adverse effects, and a doctor will work with the individual to identify the best option or combination of approaches [6].
In conclusion, dactylitis is a key inflammatory feature of psoriatic arthritis, reflecting the unique interplay of joint, tendon, and enthesis inflammation that characterises this disease. It serves as both a diagnostic clue and an indicator of disease activity and severity in PsA [1][2][3][4]. Seeking early diagnosis and treatment is crucial for managing symptoms and preventing long-term complications.
References: [1] National Psoriasis Foundation. (n.d.). Psoriatic Arthritis. Retrieved from https://www.psoriasis.org/psoriatic-arthritis [2] Tillett, S., & Menter, A. (2016). Psoriasis: Diagnosis and Management. British Journal of Dermatology, 174(6), 1167-1183. [3] Mease, P., & Gladman, D. (2016). Classification Criteria for Psoriatic Arthritis: A Systematic Review. Annals of the Rheumatic Diseases, 75(1), 11-17. [4] National Institute for Health and Care Excellence. (2018). Psoriasis: Assessment and Management. Retrieved from https://www.nice.org.uk/guidance/cg153 [5] National Psoriasis Foundation. (n.d.). Psoriasis and Dark Skin. Retrieved from https://www.psoriasis.org/get-support/community/psoriasis-and-dark-skin [6] National Psoriasis Foundation. (n.d.). Psoriatic Arthritis Treatment Options. Retrieved from https://www.psoriasis.org/treatments/psoriatic-arthritis/treatment-options
- Psoriatic arthritis (PsA), a type of psoriatic disease, affects approximately 30% of people with psoriasis, a skin condition.
- Dactylitis, characterized by painful swelling in fingers and toes, often resembling sausages, is a hallmark manifestation of PsA.
- The inflammation of flexor tendon sheaths, entheses, and surrounding soft tissues in the fingers or toes causes dactylitis.
- High-resolution ultrasound studies have identified thickening and inflammation of the fibrous bands that hold tendons close to bone in PsA patients with dactylitis.
- Clinically, the presence of dactylitis is significant for the diagnosis and disease activity assessment of PsA, often associated with joint swelling and pain.
- Early treatment of PsA can prevent or slow its progression, reducing the risk of permanent joint damage and improving overall quality of life.
- While psoriasis can appear on darker skin tones, it may be more difficult to detect due to the skin's pigmentation.
- Adverse effects of drugs for PsA require a doctor's careful consideration in identifying the best treatment option or combination of approaches for each individual.
