Enthesitis in psoriatic arthritis

• Published in: Seminars in arthritis and rheumatism 2013-12, Vol.43 (3), p.325-334
• Main Authors: Sakkas, Lazaros I., MD, DM, PhD(UK), Alexiou, Ioannis, MD, PhD, Simopoulou, Theodora, MD, PhD, Vlychou, Marianna, MD, PhD
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - complications; Assessment; Dactylitis; Disease Progression; Enthesitis; Humans; Magnetic resonance imaging; Psoriasis; Psoriatic arthritis; Rheumatic Diseases - complications; Rheumatic Diseases - diagnosis; Rheumatic Diseases - drug therapy; Rheumatology; TNFα inhibitors; Treatment; Ultrasonography
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2013.04.005

Abstract Objectives It is increasingly recognized that enthesitis in patients with psoriatic arthritis (PsA) is of clinical importance. We review data on the detection, assessment, and treatment of enthesitis and its related dactylitis in PsA. Methods We searched Pubmed with the search terms psoriatic arthritis or psoriasis in combination with enthesitis, enthesopathy, and treatment, or enthesitis in combination with imaging. Results One hundred fifty-seven papers were selected. Enthesitis occurs frequently in PsA and may be asymptomatic or painful. It can also affect patient's function and quality of life. New imaging modalities, such as ultrasonography and magnetic resonance imaging, have revealed that enthesitis may be the initial osteoarticular inflammatory site in patients with PsA. Enthesitis indices have been developed and should be incorporated in clinical trials. Dactylitis, a characteristic and frequent manifestation of PsA can be tender or not tender and is prognostic of disease progression. Treatment of enthesitis includes non-steroidal anti-inflammatory drugs, classical DMARDs, and adjunctive local steroid injections. In inadequate response, TNFα inhibitors are used. Conclusions Enthesitis and dactylitis are important manifestations of PsA, and their evaluation is increasingly used in drug trials and clinical practice.