EOP PsA patients seem to have an increased probability to have dactylitis rather than LOP ones, OR 9.64 (3.77–24.6).

The presence of dactylitis may be indicative of more severe disease among DMARD-naïve patients with early psoriatic arthritis, study findings indicate.

A post-hoc analysis of the SPIRIT-P1 and SPIRIT-P2 trials suggests that treatment with ixekizumab is associated with improvements in enthesitis and dactylitis among patients with psoriatic arthritis.

Apremilast is an effective treatment for enthesitis and dactylitis in individuals with psoriatic arthritis, according to a pooled analysis of three phase III trials.

Enthesitis and dactylitis as secondary outcomes were also reviewed.

The authors, led by Laura Coates (University of Oxford, UK), say that their recommendations “utilize a domain-based approach,” with subcommittees developing guidance spanning the six domains of PsA: peripheral arthritis; axial disease; enthesitis; dactylitis; skin psoriasis; and nail psoriasis.

In patients with psoriasis and dactylitis, fingers were more often affected than toes (76.9 vs 23.1%) whereas the reverse was true for people with pSpA without psoriasis with the fingers less likely to be affected than the toes (47.1 vs 52.9%).

The IL-17- and IL-23-targeted therapies also showed the greatest efficacy for resolution of dactylitis, followed by adalimumab and ustekinumab.

In addition, there was consistency between the monotherapy and combination therapy groups for placebo-subtracted ACR50 and ACR70 response rates at week 12, as well as rates of minimal disease activity and resolution of enthesitis and dactylitis at week 24, say Nash et al.

The poster by Köhm and co-authors also demonstrated that changes in other outcomes such as joint counts, DAPSA , PASI , enthesitis, dactylitis, and quality of life were similar between the two groups at week 24.

Guselkumab conferred improvements in arthritis, enthesitis, dactylitis, psoriasis, axial symptoms, physical function and health-related quality of life.

They note that the most common pattern of PsA experienced by patients in the study was peripheral arthritis (84%), while 20% experienced dactylitis, 16% enthesitis, and 6% axial involvement.

Patients treated with risankizumab experienced significantly greater improvements in enthesitis and dactylitis, as well as FACIT-Fatigue and SF-36 Physical Component Summary scores, relative to those given placebo.

He reported that 31% of 1704 patients in SELECT-PsA-1 and 34% of 640 in SELECT-PsA-2 had axial involvement at baseline, and these people had significantly higher tender joint counts, duration of morning stiffness, and rates of enthesitis and dactylitis than those without axial involvement.

Guselkumab also significantly improved a range of secondary endpoints relative to placebo at week 24 – including HAQ-DI , ACR50 response rates , and resolution of enthesitis and dactylitis – with further improvements seen at the 48-week follow-up.

Link to further information: https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131(200108)44:8%3C1876::AID-ART326%3E3.0.CO%3B2-F Psoriatic arthritis CPDAI Composite Psoriatic Disease Activity Index Definition: A five-domain composite score taking into account joint disease, skin involvement, enthesitis, dactylitis and spinal disease.

In general, irrespective of BMI, patients given tocilizumab versus placebo had better HAQ-DI and PASI75  response rates, dactylitis and enthesitis resolution rates, and improvements from baseline in scores on the physical and mental components of the Short-Form Health Survey-36v2, Functional Assessment of Chronic Illness Therapy-Fatigue, and HAQ-DI.