Maria Antonietta D´Agostino
Eugenio De Miguel
Andrea Delle Sedie
Marion C. Kortekaas
Jose Alexandre Mendonça
Hilde B Hammer
Jane E. Freeston
Working group OMERACT >
Gurjit Kaeley, Sibel Aydin, Esperanza Naredo, Ingrid Möller
Objective of the subgroups work:
The main objective of this group is to validate ultrasound as an imaging instrument for dactylitis for clinical trials and longitudinal observational studies in psoriatic arthritis (PsA) and related spondyloarthritis.
What is the contribution of the subgroup work to the OMERACT work?
Contribution to the Psoriatic Arthritis Working Group.
Musculoskeletal disease activity, including peripheral joints involvement, dactylitis, enthesitis, and spine symptoms are the selected domains of the updated 2016 PsA Core Domain Set. Dactylitis is now placed in the outer circle because no satisfactory measurement instruments are available. Ultrasound may be a suitable instrument to measure dactylitis on PsA.
Description of the previous work
The dactylitis subgroup has produced since 2012 the following:
1. A Literature review on dactylitis already published, underlyining the lack of data to support the use of a scoring sytem and the need to develop new instruments (i.e. Bakewell CJ, Olivieri I, Aydin SZ, Dejaco C, Ikeda K, Gutierrez M, Terslev L, Thiele R, D'Agostino MA, Kaeley GS; OMERACT Ultrasound Task Force. Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. J Rheumatol 2013) (Step1)
A Consensus on elementary lesions of dactylitis based on Delphi methodology. These elemantary lesions included digit synovial recesses, tendons, palmar/plantar plates, subcutaneous tissue, and some entheses. However, the validation of these definitions in a web-based static images reliability exercise has not been performed yet due to the difficulty to detect enthesistis of digit ligaments.
Reporting back of work done since ACR 2017
Next steps and discussion points
Recent ultrasound technological advances have greaty improved small digit enthesis imaging, which allow us to enhance our assessment of elementary lesions involved in PsA dactylitis. Based on that, a new project on polyenthesitis in dactylitis has emerged aiming at defining, evaluating and soring polyenthesitis involvement in dactylitis, based on an anatomical study of these entheses and group-consensus. Afterwards, we aim at integrating the polyenthesis scoring system in the previously initiated OMERACT scoring system for PsA dactylitis and to test its metric properties.
1. July-September 2019: DELPHI process to agree on sites and definition of enthesitis in dactylitis in PsA patients:
- Illustrated proposal of enthesitis sites sent to participants by EN & IM
- Pre-Delphi testing in healthy and PsA patients by participants
2. September-December 2019: Verification of the selected entheses in specimens + histology
3. January-March 2019: Delphi process to agree on dactylitis scoring system: previous proposal (synovitis, tenosynovitis, some entheses) + new selected entheses
4. April 2019: Reliability exercise of the agreed dactylitis scoring system in patients (Madrid)