Abstract
Dactylitis is diffuse swelling of the digits that is usually related to an underlying inflammatory or infiltrative disorder. Psoriatic arthritis (PsA) is the most common severe disease thought to cause dactylitis. Our understanding of the pathogenesis of PsA-related dactylitis comes from experimental animal models of PsA-like disease, as well as advances in imaging and other clinical studies. Clinical trials in PsA have increasingly included dactylitis as an important secondary outcome measure. These studies indicate that cytokines drive multi-locus microanatomical pan-digital pathology. Given the importance of pro-inflammatory cytokines, the pathogenesis of dactylitis is best understood as an initial aberrant innate immune response to biomechanical stress or injury, with subsequent adaptive immune mechanisms amplifying the dactylitis inflammatory response. Regarding the treatment of dactylitis, no studies have been conducted using dactylitis as the primary outcome measure, and the current knowledge comes from analysis of dactylitis as a secondary outcome measure.
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Acknowledgements
The authors thank Abed El Rahman Wattad for providing figure 3a and for help in the preparation of figure 3c. The authors also thank H. Sugimoto for providing figure 2c and d.
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Nature Reviews Rheumatology thanks B. Kirkham and the other anonymous reviewer(s) for their contribution to the peer review of this work
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D.M. declares that he has received research grants from Abbvie, Celgene, Janssen, Merck, Novartis and Pfizer and has acted as a consultant for or received honoraria from Abbvie, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer and UCB. A.L.T. declares she has acted as a consultant for or received honoraria from Abbvie, Eli Lilly, Janssen, Novartis and Pfizer. P.H. declares that he has received research grants from Abbvie and Janssen and has acted as a consultant for or received honoraria from Abbvie, Amgen, Celgene, Galapagos, Janssen, Novartis, Pfizer and UCB. A.W. declares no competing interests.
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Glossary
- Bowstringing
-
The natural tendency of the tendon to pull away from bone surface on the flexor aspect, which is being restrained by the accessory pulleys.
- Cold dactylitis
-
Dactylitis swelling without pain or tenderness.
- Deep Koebner phenomenon
-
The skeletal counterpart of skin injury in the Koebner phenomenon, whereby enthesis and joint injury can be associated with psoriatic arthritis development.
- Digital tuft
-
The terminal bony prominence at the end of the distal interphalangeal digits.
- Koebner phenomenon
-
The appearance of skin lesions in areas of cutaneous trauma, mainly (but not only) in patients with psoriasis.
- Minicircle technology
-
A method for introduction of DNA into somatic cells with resultant protein expression.
- Sesamoiditis
-
Inflammation of the sesamoid bones and/or their supporting structures.
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McGonagle, D., Tan, A.L., Watad, A. et al. Pathophysiology, assessment and treatment of psoriatic dactylitis. Nat Rev Rheumatol 15, 113–122 (2019). https://doi.org/10.1038/s41584-018-0147-9
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DOI: https://doi.org/10.1038/s41584-018-0147-9
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