Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Penélope Esther Palominos; Daniel G Fernández-Ávila; Laura C Coates; Adewale Adebajo; Adrien Nzeusseu Toukap; Ahmed Abogamal; Ari Polachek; Arno W R van Kuijk; Francesco Caso; Gabriele de Marco; Gurjit S Kaeley; Ingrid Steinkoenig; Jeffrey Chau; Marie Feletar; Marijn Vis; Ori Elkayam; Philipp Sewerin; Salvatore d'Angelo; Sibel Zehra Aydin; Waleed AlShehhi; Philip S Helliwell

doi:10.3899/jrheum.220311

Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

J Rheumatol. 2023 Feb;50(2):265-278. doi: 10.3899/jrheum.220311. Epub 2022 Nov 1.

Authors

Penélope Esther Palominos¹, Daniel G Fernández-Ávila², Laura C Coates³, Adewale Adebajo⁴, Adrien Nzeusseu Toukap⁵, Ahmed Abogamal⁶, Ari Polachek⁷, Arno W R van Kuijk⁸, Francesco Caso⁹, Gabriele de Marco¹⁰, Gurjit S Kaeley¹¹, Ingrid Steinkoenig¹², Jeffrey Chau¹³, Marie Feletar¹⁴, Marijn Vis¹⁵, Ori Elkayam¹⁶, Philipp Sewerin¹⁷, Salvatore d'Angelo¹⁸, Sibel Zehra Aydin¹⁹, Waleed AlShehhi²⁰, Philip S Helliwell²¹

Affiliations

¹ P.E. Palominos, MD, PhD, Rheumatology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; penelopepalominos@gmail.com.
² D.G. Fernández-Ávila, MD, PhD, Rheumatology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
³ L.C. Coates, MD, PhD, Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁴ A. Adebajo, MD, MBE, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.
⁵ A. Nzeusseu Toukap, MD, Rheumatology Department, Saint-Luc University Hospitals, and Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
⁶ A. Abogamal, MD, PhD, Al-Azhar Faculty of Medicine, Cairo, Egypt.
⁷ A. Polachek, MD, Department of Rheumatology, Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁸ A.W.R. van Kuijk, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, the Netherlands.
⁹ F. Caso, MD, PhD, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
¹⁰ G. de Marco, MD, Leeds Biomedical Research Center at Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK.
¹¹ G.S. Kaeley, MD, University of Florida College of Medicine, Jacksonville, Florida, USA.
¹² I. Steinkoenig, BA, GRAPPA Patient Research Partner, Cleveland, Ohio, USA.
¹³ J. Chau, MCS, GRAPPA Patient Research Partner, Hong Kong SAR, China.
¹⁴ M. Feletar, MD, Dandenong Rheumatology, Melbourne, Australia.
¹⁵ M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands.
¹⁶ O. Elkayam, MD, Department of Rheumatology, Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
¹⁷ P. Sewerin, MD, PhD, Heinrich-Heine-Universität Duesseldorf, University Hospital Duesseldorf, Department and Hiller Research-Unit for Rheumatology, Duesseldorf, Germany.
¹⁸ S. d'Angelo, MD, PhD, Rheumatology Institute of Lucania, and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy.
¹⁹ S.Z. Aydin, MD, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
²⁰ W. AlShehhi, MD, Dr. Suliman Alhabib Hospital, Dubai, UAE.
²¹ P.S. Helliwell, MD, PhD, Leeds University, Leeds, UK.

PMID: 36319013
DOI: 10.3899/jrheum.220311

Abstract

Objective: This literature review aimed to identify the most efficacious current interventions for dactylitis and provide up-to-date scientific evidence to support the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations on the management of psoriatic arthritis.

Methods: Original articles published from 2013 to 2020, registered in MEDLINE, Embase, and Cochrane Library, describing interventional trials and reporting dactylitis-related outcomes were included. The 20 members of the GRAPPA dactylitis group were divided into 9 subgroups according to treatment, and members of each group independently extracted data from articles/abstracts corresponding to their group by using a standardized data extraction form.

Results: Forty-nine publications were analyzed, representing 40 randomized clinical trials (RCTs) and including 16,752 patients. Dactylitis was assessed as a secondary outcome in 97.5% of these trials and more than 40% of RCTs did not employ a specific dactylitis measure or instrument.

Conclusion: The emergence of agents with novel mechanisms of action in recent years, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, has significantly expanded the available treatment options for dactylitis. This article points out the lack of consensus regarding dactylitis assessment and the paucity of data concerning the effect of local steroid injections, nonsteroidal antiinflammatory drugs, and conventional disease-modifying antirheumatic drugs. Clinical trials evaluating the effect of these traditional and low-cost medications used to treat dactylitis should be encouraged.

Keywords: GRAPPA; dactylitis; psoriatic arthritis; treatment.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antirheumatic Agents* / therapeutic use
Arthritis, Psoriatic* / drug therapy
Humans
Interleukin-12
Psoriasis* / drug therapy

Substances

Antirheumatic Agents
Anti-Inflammatory Agents, Non-Steroidal
Interleukin-12