Gurjit Kaeley

Sibel Aydin

Esperanza Naredo

Ingrid Möller

Maria Antonietta D´Agostino

Lene Terslev

Priscilla Wong

Carlos Pineda

Eugenio De Miguel

Mihaela Micu

Emilio Filippucci

Nemanja Damjanov

Alen Zabotti

Andrea Delle Sedie

Moh Mortada

Petra Hánová

Annamaria Iagnocco

Marion C. Kortekaas

Jose Alexandre Mendonça

Sarah Ohrndorf

Violeta Vlad

Zunaid Karim

Luca Idolazzi

Georgios Filippou

David Kane

Marcin Szkudlarek

Catherine Bakewell

Hilde B Hammer

Peter Balint

Marwin Gutierrez

Jane E. Freeston

Peter Mandl

Ilaria Tinazzi

David Bong




















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.

Planned agenda:

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)