Background/Purpose:

Dactylitis, also called “sausage fingers”, is considered one of the differential signs characteristic of Spondyloarthritis (SpA). The absence of knowledge of its pathophysiology make it a clear manifestation of a difficult clinical treatment. The use of imaging techniques, such as resonance or ultrasound, have demonstrated that there is more inflammation at the level of the tendons than synovitis, with soft edema parts, and that the target organ in these cases is the enthesis. The standardized treatment is the use of NSAIDs, steroids and local infiltration. Different biological treatments have shown good results (secukinumab, antiTNFs).

Our objective is to evaluate how local infiltration with steroids modifies both expression clinical, and echographic changes typical of dactylitis. As well as evaluate if there is a difference between the guided ultrasound Vs infiltration.

Methods:

Clinical trial, randomized, with blind and unicentric radiological evaluation. They were included

patients with clinical dactylitis who presented echographic signs that confirmed the diagnosis. All of them tributaries of local infiltration with steroids. Simple patients’ randomization was done, according to the order of assignment in the study. Paired patients with conventional infiltration and odd patients with guided ultrasound infiltration. The response to the t

reatment using ultrasound (tenosynovitis, synovitis and Doppler) and clinical criteria were evaluate at 2 and 6 months of infiltration. The assessment of the clinical remission of dactylitis was made under the yes or no dichotomous variable. The assessment of clinical remission of dactylitis was assessed when the Flexor tenosynovitis and Doppler scored 0.

Results:

A total of 28 patients were collected, with a total of 50 fingers, the average age was

47.57 ± 10.99, with an average of fingers per patient of 1.78 ± 0.56. 42.9% were

diagnosed of psoriatic arthritis, the rest still to be affiliated. All the patients presented

clinical and ultrasonographic dactylitis, 100% ecográgica tenosinovitis with positive PWD signal, 54%

(27) grade 1 and 46% (23) grade 2. Of the 28 patients, 16 had MCF arthritis and 12 of them MCF and IFP.

They underwent conventional infiltration to 28 Vs 22 patients who were echoguided. Two months after the infiltration, clinical and sonographic remission was achieved in 68% (34) maintained after 6 months of follow-up. Front the 34 fingers that achieved remission, 21 performed ultrasound-guided infiltration and 13 conventional (p 0.002). Only arthritis was resolved associated in 2 of the patients.

Conclusion:

We can conclude that steroid infiltration guided by ultrasound is a good option treatment in patients with dactylitis. Conventional infiltration should not be done given the low efficiency.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-infiltration-with-steroids-in-dactilitis-is-the-infiltration-guided-by-ecography-better-than-conventional/