Isolated Index Finger Dactylitis with Hilar Adenopathy

Dactylitis due to tuberculosis (TB) is an extremely uncommon manifestation of TB. We report a unique case of isolated index finger dactylitis with right hilar adenopathy due to TB in a 15-year-old immunocompetent student. High index of clinical suspicion, radiological findings and histological confirmation helped in the diagnosis. Anti-tuberculous therapy remains the cornerstone for the management of these cases.

Benefit of ultrasound in the phenotype recognition of psoriatic arthritis / 北京大学学报(医学版)

OBJECTIVE@#To explore the difference in phenotype recognition of PsA patients in two clinical scenarios, physical examination with and without ultrasound assessment.@*METHODS@#PsA patients who visited the rheumatology and clinical immunology department of Peking University First Hospital between January 2010 and October 2020, with complete data of clinical and ultrasound assessment were enrolled. The phenotypes were first identified based on physical examination only, and then combined with enthesitis and dactylitis shown on power doppler and gray-scale ultrasound. The phenotype groupings without and with ultrasound assessment were presented with Wayne diagram. The distributions of different clinical phenotypes were compared by using χ2 test or Fisher's exact test. The differences of clinical phenotypes with and without ultrasound assessment were compared by using Wilcoxon signed rank test.@*RESULTS@#A total of 227 patients with PsA were enrolled with one or more clinical domains. Physical examination revealed that psoriasis was in 209 (92.1%, 209/227) patients, nail involvement in 98 (43.2%, 98/227) patients, peripheral arthritis in 219 (96.5%, 219/227) patients, axial involvement in 25 (11.0%, 25/227) patients, dactylitis in 80 (35.2%, 80/227) patients, and enthesitis in 18 (7.9%, 18/227) patients. Besides 18 patients with clinical enthesitis, ultrasound scan revealed acute enthesitis in 80 patients, with hypoechogenicity (55 cases), tendon thickening (62 cases), and presence of Doppler signals (48 cases). Similarly, dactylitis on ultrasound was found in 18 patients besides those patients with clinical dactylitis. Compared with the phenotypes recognized based on physical examination only, the additional ultrasound assessment revealed that the most common phenotypes, peripheral arthritis was significantly less frequently recognized (49.8% vs. 27.8%, P < 0.001), however on the other hand, the proportion of the patients with peripheral arthritis and enthesitis was significantly increased (4.4% vs. 18.1%, P < 0.001). The phenotype of peripheral arthritis combined with enthesitis, and dactylitis was also dramatically increased (1.8% vs. 17.6%, P < 0.001).@*CONCLUSION@#Ultrasound is a useful tool to identify enthesitis and dactylitis. With the aid of ultrasound assessment, rheumatologists can better identify the lesions of PsA, accurately identify the phenotypes, and further guide the subsequent treatment.

A study on comparison of gender-based prevalence and severity at presentation in spondyloarthritis in a tertiary care rheumatic center

Introduction: Spondyloarthritis (or spondyloarthropathy) is the overall name for a family of inflammatory rheumatic diseases that can affect the spine and joints, ligaments and tendons These diseases can cause fatigue and pain or stiffness in the back, neck, hands, knees, and ankles as well as inflammation of the eyes, skin, lungs, and heart valves While there is no course of prevention at this time treatment can reduce discomfort and delay the development of spinal deformities Aim of the study: The aim of the study was to differentiate gender difference at presentation of spondyloarthritis and to identify markers in determining the severity of disease Materials and methods: This was a prospective observational study conducted for a period of 6 months at Institute of Rheumatology, Government KAPV Medical College and MGM Government Hospital Totally 62 patients were included in the study 31 males and 31 consecutive females with features of spondyloarthritis per ASAS (Assessment of Spondyloarthritis international Society) at first presentation to our clinic were enrolled and their clinical characteristics were analyzed Results: On comparing disease activity and functional indices between males and females, mean BASDAI was 466±18 versus 498±194 (p=05), mean BASFI was 46±23 versus 48±23 (p=07), TN Tamil Selvam, VA Sowndhariya, NK Senthil Nathan A study on comparison of gender-based prevalence and severity at presentation in spondyloarthritis in a tertiary care rheumatic center IAIM, 2018; 5(12): 35-39 Page 36 mean BASMI was391±194 versus 418±206 (p=04) Out of 31 males, 17 were positive for HLA B27 and 6 out of 31 females were positive for HLA B27 (p=004) Conclusion: The pathogenesis of SpA is multifactorial and not yet fully understood Genetic factors (HLA-B27 and non– HLA-B27 related genes), inflammatory cytokines (eg TNF-alpha, IL-1, IL-6, IL-7, IL-17, and IL-23) and environmental triggers (infections, mechanical stress, abnormal intestinal microbiota) play an important role These different factors and their complex interaction can lead to activation of autoinflammation and autoimmunity and to the new bone formation Men are more prone to spondyloarthritis when compared with women

Tuberculous dactylitis: A case report.

Tuberculous dactylitis (TD) is an uncommon presentation. It is also known as spina ventosa. Mycobacterium tuberculosis is the causative agent responsible for Tuberculosis. We here present a case of a young adolescent female presenting with complaints of pain and swelling in middle finger region for the last seven month. She was diagnosed as case of tubercular dactylitis and was managed surgically along with anti-tubercular chemotherapy.

Isolated Spina Ventosa: An Extremely Rare Presentation of Skeletal Tuberculosis in Adolescent Age.

Even though the prevalence of tuberculosis is very high in the developing world, skeletal tuberculosis of extremities rarely occurs. Here we report an uncommon form of bone tuberculosis in a 16 year old female presenting as tubercular dactylitis of proximal phalanx of right middle finger confirmed by Histopathology.

Diagnosis and management of psoriatic arthritis.

Psoriatic arthritis (PsA) is a multi-faceted disease marked by varying combinations of peripheral arthritis, dactylitis, spondylitis, and enthesitis. Rarely, recurrent uveitis occurs. Skin involvement may or may not exist. However, patients with nail psoriasis have a higher probability of developing PsA. Untreated patients have significant morbidity and mortality. Timely diagnosis and aggressive treatment of the disease can lead to lower morbidity. Drug therapy of PsA includes symptomatic therapy and therapy with disease-modifying antirheumatic drugs. Biologics are the only agents that address all the pathological changes, of this chronic condition.

Diagnosis and management of psoriatic arthritis.

Psoriatic arthritis (PsA) is a multi-faceted disease marked by varying combinations of peripheral arthritis, dactylitis, spondylitis, and enthesitis. Rarely, recurrent uveitis occurs. Skin involvement may or may not exist. However, patients with nail psoriasis have a higher probability of developing PsA. Untreated patients have significant morbidity and mortality. Timely diagnosis and aggressive treatment of the disease can lead to lower morbidity. Drug therapy of PsA includes symptomatic therapy and therapy with disease-modifying anti-rheumatic drugs. Biologics are the only agents that address all the pathological changes, of this chronic condition.

Dactylitis in a Patient with Psoriatic Arthritis Treated with Infliximab / 대한내과학회지

Dactylitis is a hallmark feature of psoriatic arthritis. It is usually managed with non-steroidal anti-inflammatory drugs and oral corticosteroids. Some cases have been treated successfully with intravenous corticosteroids or some disease-modifying antirheumatic drugs. Recently, inflximab has been reported as an effective treatment for dactylitis that is resistant to conventional treatment. This report describes a 37-year-old man with psoriatic arthritis who had multiple dactylitis on both thumbs and great toes. He was resistant to conventional treatment but was effectively treated with infliximab. This report highlights the effectiveness of infliximab for dactylitis, and the usefulness of blood pool imaging from bone scans as a method for determining treatment response.

Espondiloartritis en el Hospital Pablo Tobón Uribe. Descripción de una cohorte / Hospital Pablo Tobón Uribe-Spondyloarthropathies. A cohort description

Las espondiloartritis comparten un contexto ambiental, genético y clínico. Objetivo. Conocer y describir el comportamiento demográfico, clínico y radiológico de pacientes con espondiloartritis en el Hospital Pablo Tobón desde el 1 de enero de 2005 hasta el 31 de diciembre de 2008. Materiales y métodos. Este es un estudio descriptivo, observacional, de corte transversal. Se empleó estadística descriptiva para las variables demográficas, clínicas, radiológicas y los diversos tipos de tratamiento. Resultados. 71 pacientes fueron identificados. Las características clínicas más importantes fueron: dolor lumbar inflamatorio en el 84% de los pacientes, entesopatía, 67%; artritis periférica, 64% y dolor glúteo alternante, 57%. Las articulaciones comprometidas con mayor frecuencia fueron: sacroilíacas, 62%; tobillos, 32%; rodillas, 30%; tarso, 14%. El 64% presentó sacroilitis radiológica. Las manifestaciones extraarticulares más frecuentes fueron: dactilitis, 22%; uveítis, 19%; compromiso renal, 5% y fibrosis pulmonar, 1%. Los índices de actividad (BASDAI) fueron de 4.82 y la función (BASFI) de 4. 54% y 34% de los pacientes tenían eritrosedimentación y PCR elevada, respectivamente. El HLA B27 + en el 52%. Los DMARDs (sulfasalazina y metotrexate) fueron los medicamentos más usados en el 68% de los casos. Le siguieron los AINES en el 52% y los medicamentos anti-TNF en el 42% de los pacientes (Infliximab 20%, adalimumab 16% y etanercept 6%). Conclusión. Nuestros pacientes tenían una enfermedad activa y con limitación funcional. Se encontró un alto porcentaje de pacientes con espondiloartritis indiferenciada. La dactilitis fue la manifestación extraarticular más frecuente y el compromiso radiológico fue similar al descrito en la literatura. Palabras clave: espondiloartritis, índices de actividad, dactilitis, entesitis.

Spondyloartropahties share a genetic, clinical and environmental context. Objective. To describe demographic, clinical and radiological characteristics of spondyloarthropathies in a tertiary hospital. Methods. Descriptive analysis of a 71 patients. Demographics, clinical, radiological and treatment modalities are shown. Results. A total of 71 patients were identified. Low back pain 84%, entesopathye 67%, peripheral arthritis 64% and alternant buttock pain were often seen. The most common joint involved were sacroiliac joints 62%, ankles 32%, knees 30%, tarsal joints 14%. Radiological sacroiliacs involvement 64%. Dactilytis 22%, uveitis 19%, renal and pulmonary involvement were seen 5% and 1% respectively. Activity and functional indexes were (BASDAI) 4.82 and (BASFI) 4. High ESR and PCR were seen 54% and 34%, while HLA B27+52%. DMARDs (sulfasalazine and methotrexate) were used 68%. NSAIDs 52%. Anti-TNF blockers 42% (Infliximab 20%, adalimumab 16% and etanercept 6%). Conclusion. Our patients shown an active disease. A high incidence of undifferentiated spondyloarthropahies was found. Dactylitis was the most common extraarticular manifestation and radiological findings were similar to previously reported in the literature.

Cystic bone tuberculosis in children - A case series.

Cystic tuberculosis of the bone is a rare form of tuberculosis (TB) osteomyelitis associated with disseminated lesions. In children, the lesions involve the peripheral skeleton, are symmetric and less sclerotic while in adults, the lesions are axial and predominantly sclerotic. TB dactylitis and spina ventosa are the other common variants of TB osteomyelitis seen in children below five years. Here we report seven cases of cystic TB bone disease. There were three males and four females with age of diagnosis between 2-11 years. Most patients presented with localized swelling and pain. X-rays revealed classical cystic lesions and spina ventosa. Four children had multiple cystic lesions and three had isolated lesions. Diagnosis was confirmed by FNAC of the bone or histopathological / radiological evidence of TB. The patients responded well to anti-tubercular therapy. The entity of cystic TB bone disease should be borne in mind as, lack of awareness may delay diagnosis and treatment. Biopsy is mandatory to confirm diagnosis and antitubercular drugs are the mainstay of therapy. Curettage of affected bone in selected cases may promote early healing. Response to therapy is excellent and the overall prognosis is good.

Spina Ventosa discharging tubercle bacilli - a case report.

Tubercular dactylitis is an unusual form of skeletal tuberculosis. Radiographic features of cystic expansion of the short tubular bones have led to the name of “Spina Ventosa” for tuberculosis dactylitis of the short bones. We report here a case of a Spina Ventosa in a 15 year-old female, who presented with complaint of draining sinus on the dorsum of the third digit of the left foot.

Tuberculous Dactylitis - A rare manifestation of adult Skeletal Tuberculosis.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and manifested by formation of tubercles and caseous necrosis in tissues. In the musculoskeletal system, tuberculous spondylitis is the most typical form of the disease; however, joint changes in extraspinal sites, such as the hip, knee, wrist and elbow, also may occur. Other abnormalities commonly encountered are tuberculous dactylitis and involvement of the tendon sheath. Characteristically, the tissues respond to the mycobacterial infection by forming tubercles. Clusters of epithelial cells surround a central zone of caseating necrosis, with the central part of the tubercle being composed of multinucleated giant cells and the periphery consisting of a mantle of lymphocytes. Special types of tuberculous osteomyelitis include cystic tuberculosis and tuberculous dactylitis. The radiographic characteristics of cystic tuberculosis resemble those of eosinophilic granuloma, sarcoidosis, cystic angiomatosis, plasma cell myeloma, fungal infections, metastases and other conditions. Tuberculous dactylitis involving the short tubular bones of the hands and feet occurs especially frequently in children. In addition to soft tissue swelling, periostitis of phalanges, metacarpals or metatarsals may be evident. Expansion of the bone with cystic quality is termed spina ventosa.Tuberculosis of the metacarpals ,metatarsals and phalanges is uncommon after the age of five years.

A Case of Sarecoid Dactylitis / 대한피부과학회지

We report a case of sarcoid dactylitis in which there have been significant bone changes. A 46 year-old female presented with digital erythematous clubbing-like changes and sausage-like swellings of middle phalanges of both hands for 3 months. She had also several freely movable nontender subcutaneous nodules on her trunk and extremities for 3 years. There was a mild leukopenia and decreased cell-mediated immunity. The chest X-ray revealed bilateral hilar lymphadenopathy with increased interstitial lung markings. The X-ray of the hands and feet revealed paraarticular osteolytic lesions and altered trabecular patterns. Histopathologically there were several well-circumscribed granulomas without any caseating necrosis. We treated her with oral prednisone and hydroxychloroquine with some improvement.

Sarcoid Dactylitis / 결핵

The reports of sarcoidosis have increased in Korea since 1968. Osseous sarcoidosis is 3%-5% of sarcoidosis, but it is not reported upto date in Korea. So, we report a case of sarcoid dactylitis. A 47-year old woman who complained of painful swelling in her fingers was admitted in Korea University Guro Hospital. She had visited local clinics 3 years ago for chronic cough, multiple subcutaneous nodules and erythematous elevated regions on extensor sides of both extremities, and taken medicine under the diagnosis of pulmonary tuberculosis for 3 years. On admission her distal phalanges showed fusiform swelling, and multiple 1 cm-sized papules were found on the extensor area of extremities. The chest CT scan and the skin biopsy which had been performed in local clinics were reviewed to examine whether it was tuberculosis or not, but the results were compatible to sarcoidosis. So, under the impression of sarcoidosis chest CT and biopsy of hand lesions were performed again. And the patient was prescribed prednisolone 30 mg, and Hydroxychloroquine 400 mg per day, and then showed improvement of pain and skin lesions.