Rheumatology 2021;0:1

Clinical vignette

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doi:10.1093/rheumatology/keab476
Advance Access publication 11 June 2021

Dactylitis in psoriatic arthritis: a histologic FIG. 1 Clinical, radiological and histological findings
description
A 76-year-old man presented with a 3-year history of
pain and swelling on the third finger of his right hand,
associated with recurrent metacarpophalangeal inflam-
matory arthralgia, which has worsened in the last
4 months. He did not report lesions of any kind on the
skin or nails, or a family history of psoriasis or rheumatic
diseases. He had been submitted to bone and synovial
biopsies in order to exclude an infectious aetiology of
the digital oedema before the attendance in our rheum-
atological unit. The physical examination showed a dif-
fuse and uniform swelling of the third finger of the right
hand between the MCP and PIP, and the PIP and DIP
joints, with local warm, compatible with dactylitis. There
was arthritis on the second and fifth MCP joints of the
same hand and skin lesions compatible with psoriasis in
the extensor region of the elbows. In addition, there was
an increase in inflammatory tests and negative RF. He
was diagnosed with PsA. The patient’s clinical, radio-
logical and histological findings are shown in Fig. 1.
We take advantage of this typical case to present the
histological characterization of dactylitis in PsA, previ-
ously described in children [1]. To our knowledge this is (A) Dactylitis on the third finger associated with second
the first description of histological dactylitis in an adult. and fifth MCP arthritis. (B) Plain radiography of the right
Funding: No specific funding was received from any hand, posteroanterior view, showing diffuse soft tissue
bodies in the public, commercial or not-for-profit sectors oedema, cortical irregularity in the second MCP joint,
to carry out the work described in this article. and a continuity solution in the cortical of the third prox-
imal phalanx representing the post-biopsy sequelae.
Disclosure statement: The authors have declared no MRI, fat suppressed proton density, axial (C) and cor-
conflicts of interest. onal (D) view of the right hand, showing peritendum
hypersignal in the flexor compartment of the third finger,
associated with focal signs of oedema in the subcutane-
Data availability statement ous tissue. (E) The synovial membrane is with marked
Data are available upon reasonable request by any qualified villous pattern, with fibrin deposits and neovasculariza-
researchers who engage in rigorous, independent scientific tion, haematoxylin and eosin. (F) Synovial membrane
research, and will be provided following review and approv- showing lymphohistiocytic inflammatory cell infiltrate,
al of a research proposal and Statistical Analysis Plan with fibrinous deposits and fibrovascular proliferation,
(SAP) and execution of a Data Sharing Agreement (DSA). haematoxylin and eosin.
All data relevant to the study are included in the article.

Aurivan E. Dantas1, Cristina C. D. Lanna2, 260, Belo Horizonte, MG, Brazil.

Moises S. Pedrosa3 and Gustavo G. Resende4 E-mail: reumato.aurivanessado@gmail.com
1
Rheumatology Department, Hospital das Clı́nicas,
2
3
Locomotor Apparatus Department, Medical School, References
Pathology Department, Hospital das Clı́nicas and
4
Rheumatology Department, Hospital das Clı́nicas, 1 Tuttle KS, Vargas SO, Callahan MJ, Bae DS, Nigrovic
Universidade Federal of Minas Gerais, Belo Horizonte, PA. Enthesitis as a component of dactylitis in psoriatic
Minas Gerais State, Brazil juvenile idiopathic arthritis: histology of an established
clinical entity. Pediatr Rheumatol Online J 2015;13:7.
Correspondence to: Aurivan E. Dantas, Street Alameda
Álvaro Celso, 175, 2 Andar, Santa Efigênia, CEP 30.150-

C The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com
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