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Prevalence and Characteristics Associated with Dactylitis in Patients with Early Spondyloarthritis: Results from the Esperanza Cohort M.I

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Prevalence and Characteristics Associated with Dactylitis in Patients with Early Spondyloarthritis: Results from the Esperanza Cohort M.I Prevalence and characteristics associated with dactylitis in patients with early spondyloarthritis: results from the ESPeranza cohort M.I. Tévar-Sánchez1, V. Navarro-Compán2, J.J. Aznar3, L.F. Linares4, M.C. Castro5, E. de Miguel2, on behalf of the Esperanza Group 1Rheumatology Department, Hospital Vega Baja, Orihuela, Alicante, Spain; 2Rheumatology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; 3Rheumatology Department, Hospital de Mérida, Mérida, Badajoz, Spain; 4Rheumatology Department, Clínica Universitaria Hospital Virgen de la Arrixaca, Murcia, Spain; 5Rheumatology Department, Hospital Universitario Reina Sofía, Cordoba, Spain. Abstract Objective Dactylitis is a typical feature of psoriatic arthritis. However, dactylitis was included as a spondyloarthritis (SpA) feature for both (axial and peripheral) of the ASAS classification criteria, but data about its prevalence are scarce, especially in patients with a recent onset of the disease. Our objective was to determine the prevalence and characteristics associated with dactylitis in patients with early SpA. Methods A baseline dataset from the ESPeranza cohort was used. This programme included patients who were suspected of having SpA (age <45 years, symptoms duration of 3–24 months and with inflammatory back pain, or asymmetrical arthritis, or spinal/joint pain plus ≥1 of the SpA features). For this study, 609 patients who were diagnosed with SpA by their physician were included. Descriptive, univariable and multivariable logistic regression analyses were employed to investigate the association between the presence of dactylitis and the characteristics associated with SpA. Results Fifty-eight (9.5%) patients currently or previously had dactylitis. In the multivariable analysis, dactylitis was independently associated with peripheral arthritis (OR= 4.83; p<0.001), enthesitis (OR= 2.49; p=0.01), psoriasis (OR= 3.62; p<0.01) and the physician’s visual analogue scale (OR= 0.82; p=0.01). However, 67% of the patients who had dactylitis did not have peripheral arthritis or psoriasis and 15% had predominantly axial disease. Conclusion Dactylitis is a frequent manifestation in patients with SpA, even during the early stages of the disease. Its presence is mainly associated with peripheral manifestations and psoriasis. Nevertheless, dactylitis is not exclusive of patients with PsA or peripheral manifestations. Key words dactylitis, spondyloarthritis, psoriatic arthritis Clinical and Experimental RheumatologyClinical 2018 and Experimental Rheumatology 2018; 36: 879-883. Dactylitis in early spondyloarthritis / M.I. Tévar-Sánchez et al. María Isabel Tévar-Sánchez, MD Introduction Materials and methods Victoria Navarro-Compán, MD, PhD Spondyloarthritis (SpA) describes a Study design and population Juan José Aznar, MD group of diseases characterised by axial This observational study was performed Luis Francisco Linares, MD and/or peripheral inflammatory joint in- within the framework of the ESPeranza Maria del Carmen Castro, MD, PhD Eugenio de Miguel, MD, PhD volvement, with or without the presence programme, a Spanish prospective of extra-articular manifestations, which multicentre national health programme Please address corresponding to: Dr Eugenio de Miguel, includes dactylitis, uveitis, inflamma- aiming to facilitate early diagnosis of Rheumatology Department, tory bowel disease (IBD) and psoriasis patients with SpA (8). In summary, Hospital Universitario La Paz, (1). this was a national initiative in which Pº de la Castellana 261, Dactylitis is frequently seen in psori- patients who were suspected as having 28046 Madrid, Spain. atic arthritis (PsA), but it may also be early SpA were referred to 25 different E-mail: [email protected] present in other forms of SpA. Dacty- centres (8, 9). The patients fulfilled the Received on November 1, 2017; accepted litis, which is also known as ‘sausage- following inclusion criteria: 1) age <45 in revised form on February 26, 2018. like’ digits, is defined by Rotschild as years, 2) symptom duration between 3 © Copyright CLINICAL AND the “uniform swelling such that the soft and 24 months, and 3) at least one of EXPERIMENTAL RHEUMATOLOGY 2018. tissues between the metacarpophalan- the following: a) inflammatory axial geal and proximal interphalangeal, pain (defined by the presence of two proximal and distal interphalangeal, of the following characteristics: insidi- and/or distal interphalangeal joint and ous onset, improvement with exercise digital tuft are diffusely swollen to and worsening with sleep, and morning the extent that the actual joint swell- stiffness of 30 minutes), b) asymmetric ing can no longer be independently arthritis, especially in the lower limbs, recognised” (2). Several diseases are c) spinal pain (at any level) or joint included in the differential diagno- pain, plus one of the following features sis of dactylitis. However, in the past of SpA: psoriasis, IBD, anterior uveitis, few years, magnetic resonance imag- radiographic sacroiliitis, human leuco- ing (MRI) and ultrasound have shown cyte antigen B27 (HLA-B27) positivity, Funding: The Spanish Foundation of that the sausage-like digit appearance or a family history of SpA, psoriasis, Rheumatology received funding from in patients with SpA is clearly differ- IBD or anterior uveitis. For this spe- Pfizer to develop the ESPeranza ent from the digit appearance of other cific study, the baseline data from all Programme. Currently, the programme is supported by a restricted grant from the diseases, such as tuberculous dactylitis, patients diagnosed with SpA by the lo- Instituto de Salud Carlos III and FONDOS syphilitic dactylitis, sarcoid dactylitis, cal rheumatologist at each centre were FEDER (FIS PI13/02034). The sponsor blistering distal dactylitis or sickle cell analysed. had no role in the study design, collection, disease dactylitis (3). In the dactylitis All patients signed an informed consent analysis or interpretation of the data, the that is seen in SpA, flexor tenosyno- before their inclusion. The programme writing of the report, or in the decision to vitis together with diffuse soft tissue was reviewed and approved by the Re- submit the article for publication. oedema seems to be the sine qua non search Ethics Committee of Hospital Competing interests: I.M. Tévar-Sánchez condition for the development of the Reina Sofía in Cordoba, Spain. The ap- received grants from Pfizer, personal fees ‘sausage-like’ appearance (4, 5). proval covers the analysis of the data from MSD, personal fees from Bristol Myers Squibb, outside the submitted In PsA, the prevalence of dactylitis has described in this study. work; V. Navarro-Compán received been estimated as being 16% to 52%, speaking fees or funding for research but the prevalence of this extra-articu- Variables projects and attending congresses from lar manifestation in the other subtypes For all patients, a detailed medical his- Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, of SpA and during the first stages of tory and examination were performed, Roche and UCB; J.J. Aznar received the disease is not well established. In and data were collected and registered personal fees from Abbvie, personal fees addition, dactylitis has been included using an electronic form, including from Novartis, personal fees from Pfizer, outside the submitted work; L.F. Linares as one of the typical features for both gender, age and clinical SpA features: received grants and personal fees from axial and peripheral ASAS SpA classi- IBP characteristics, enthesitis, arthritis, Abbvie, personal fees from Novartis, fication criteria (6, 7). dactylitis (defined as uniform swell- ppersonal fees from MSD, outside the Based on this, the objective of the pre- ing such that the soft tissues between submitted work; M.C. Castro received sent study was twofold: (a) to describe the metacarpophalangeal and distal in- personal fees from Abbvie, Novartis, the prevalence of dactylitis in patients terphalangeal joint and digital tuft are Pfizer, MSD, Jannsen, UCB, outside the with early SpA and in the different SpA diffusely swollen to the extent that the submitted work; E. de Miguel received grant/research support from Abbvie and subtypes and (b) to determine which actual joint swelling can no longer be Pfizer, honorarium as speaker from clinical and disease characteristics are independently recognised), psoriasis, Abbvie, MSD and Novartis and consultant associated with dactylitis in patients IBD, diarrhoea, urethritis, cervicitis, fees from Abbvie and Novartis. with early SpA. prostatitis, a positive family history for 880 Clinical and Experimental Rheumatology 2018 Dactylitis in early spondyloarthritis / M.I. Tévar-Sánchez et al. SpA, and a good response to non-steroi- Table I. Demografic and disease characteristics in patients with or without dactylitis. dal anti-inflammatory drugs (NSAIDs). Characteristic No dactylitis Dactylitis p-value The complementary examinations that (n=551) (n=58) were included are lab tests of C-reac- tive protein (CRP), erythrosedimenta- Age (years) 33.1 ± 7.2 33.8 ± 7.4 0.5 tion rate (ESR), and HLA-B27, and Gender (male) 323 (58.6) 36 (62.1) 0.6 Symptom duration (months) 11.6 ± 6.6 11.9 ± 7.4 0.8 conventional radiography of sacroiliac CBP 483 (87.7) 28 (48.3) <0.001 joints, if available. MRI was not includ- IBP (ASAS criteria) 246 (44.6) 11 (19) <0.001 ed in the protocol as a mandatory test, Response to NSAIDs 330 (59.9) 29 (50) 0.2 but all participating centres were asked Peripheral arthritis 125 (22.7) 44 (75.9) <0.001 to perform it, if possible. Enthesitis 101 (18.3) 28 (48.3) <0.001 Psoriasis 69 (12.5) 19 (32.8) <0.001 Nail lesions 10 (1.8) 4 (6.9) 0.01 Statistical analysis IBD 32 (5.8) 1 (1.7) 0.2 First, a descriptive analysis was per- Uveitis 27 (4.9) 1 (1.7) 0.3 formed to determine the number (per- Diarrhoea, cervicitis, urethritis 14 (2.5) 4 (6.9) 0.06 centage) of patients with dactylitis and Family history of SpA 148 (26.9) 13 (22.4) 0.5 HLA-B27 positive (n=597) 254 (46.1) 23 (39.7) 0.5 to compare the characteristics between CRP 8.7 ± 17.1 14.8 ± 17.1 0.01 the patients with or without dactylitis.
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