Comprehensive description of the prevalence, serological and clinical characteristics, and visceral involvement of systemic sclerosis (scleroderma) in a large cohort from the United Arab Emirates Systemic Sclerosis Registry.

Systemic sclerosis is an autoimmune condition characterized by a wide range of clinical presentations. Registries may serve to expand understanding about systemic sclerosis and aid in patient care and follow-up. The objective of this study was to analyze the prevalence of systemic sclerosis in a large cohort from the United Arab Emirates Systemic Sclerosis Registry and find the significant similarities and differences between the different subsets. All scleroderma patients in the United Arab Emirates were included in this multicenter national retrospective analysis. Data on demographics, comorbidities, serological characteristics, clinical aspects, and treatment were collected and analyzed, highlighting the most common traits identified. A total of 167 systemic scleroderma patients from diverse ethnic backgrounds were enrolled. Overall, 54.5% (91/167) of the patients were diagnosed with diffuse cutaneous systemic sclerosis, and 45.5% (76/167) with limited cutaneous systemic sclerosis. The prevalence of systemic sclerosis was 1.66 per 100,000 for the total registry and 7.78 per 100,000 for United Arab Emirates patients. Almost all patients in the diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis groups tested positive for the immunofluorescence antinuclear antibody. Antibodies against Scl-70 were significantly more associated with diffuse cutaneous systemic sclerosis, whereas anticentromere antibodies were significantly more associated with the limited cutaneous systemic sclerosis group (p < 0.001). Sclerodactyly, shortness of breath, and digital ulcers were more common in diffuse cutaneous systemic sclerosis patients compared with the limited cutaneous systemic sclerosis subtype in terms of clinical symptoms and organ involvement. Telangiectasia was much more common in the limited cutaneous systemic sclerosis group. Furthermore, diffuse cutaneous systemic sclerosis patients had more lung fibrosis (interstitial lung disease) than limited cutaneous systemic sclerosis patients (70.5% vs 45.7%), and pulmonary arterial hypertension was twice as common in limited cutaneous systemic sclerosis patients as it was in diffuse cutaneous systemic sclerosis patients. Local registries are paramount to understanding the clinical/serological characteristics of scleroderma. This study emphasizes the importance of raising disease awareness and distinguishing between the various systemic sclerosis subsets to implement patient-tailored strategies for early detection, better management, and higher quality of care.

Comparison between Distal Extension Attachment-retained Removable Partial Prostheses with Integrated and Conventional Reciprocation Designs: A Clinical Trial.

AIM: To compare marginal bone level (MBL) around the abutments in integrated and conventional reciprocation designs in attachment-retained removable partial prosthesis (A-RPP). MATERIALS AND METHODS: Around 14 participants were indiscriminately selected and separated into two groups. For every group, an A-RPP with one of the studied reciprocation types was fabricated and assessed. Group I received A-RPP with integrated reciprocation and group II received A-RPP with conventional reciprocation. MBL around the crowned primary and secondary abutments was assessed on the day of A-RPP insertion, at 6 and at 9 months of denture use. RESULTS: Comparison of MBL values at the primary and secondary abutments within each group showed no statistical difference from time of delivery and throughout the study. After using the A-RPP for 6 and 9 months, group I revealed lower mean values of MBL than group II which were statistically significant. CONCLUSION: Distal extension A-RPP with integrated and conventional reciprocation designs were associated with raise in bone loss. Integrated reciprocation design revealed a lesser amount of bone loss than the conventional reciprocation design and therefore, it is considered as more preferable to be used. CLINICAL SIGNIFICANCE: Distal extension A-RPP with integrated reciprocation is superior in terms of periodontium preservation around abutment teeth as compared to distal extension A-RPD with conventional reciprocation.

Doctor for Every Citizen: Telehealth Visits at Dubai Health Authority during COVID-19 Pandemic in Dubai, United Arab Emirates.

BACKGROUND: Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. METHODS: This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. RESULTS: Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. CONCLUSIONS: This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai.

Prevalence and associated risk factors of overweight and obesity among adult population in Dubai: a population-based cross-sectional survey in Dubai, the United Arab Emirates.

OBJECTIVE: To study the prevalence of overweight and obesity and determine the associated risk factors among adults in Dubai. DESIGN AND SETTING: A cross-sectional survey with a multistage, stratified random sampling design was conducted in the Emirate of Dubai in 2019. PARTICIPANTS: The study included 2142 adults aged 18+ years in the Emirate of Dubai. RESULTS: The overall prevalence of obesity, which was defined as body mass index (BMI) ≥30 kg/m2, was 17.8%. The highest obesity rates were reported among women (21.6%) and the United Arab Emirates (UAE)-nationals (39.6%). Moreover, 39.8% of the population was overweight (BMI ≥25-29.9 kg/m2). Multivariate logistic regression showed associations between obesity and age, sex, nationality, hypertension and occupation. Obesity increases with age, with the highest risk at age group 50-59 years (OR 4.30; 95% CI 1.57 to 11.78) compared with the reference group (18-24 years). Females had a higher risk of obesity than males (OR 1.62; 95% CI 1.10 to 2.38). Compared with those in the reference group (Western and others), UAE nationals, other Arabs and Asians were more likely to be obese ((OR 2.08; 95% CI 1.18 to 3.67), (OR 3.61; 95% CI 2.41 to 5.44) and (OR 1.98; 95% CI 1.12 to 3.50), respectively). Clerical and service workers (OR 4.50; 95% CI 2.54 to 8.00) and elementary and unskilled occupation categories (OR 2.57; 95% CI 1.56 to 4.25) had higher risks of obesity than the reference group (professionals), p<0.01). Hypertensive individuals had a higher risk of obesity than normotensive individuals (OR=3.96; p<0.01). CONCLUSIONS: Obesity and overweight are highly prevalent among adults in Dubai and are remarkably associated with sociodemographic and behavioural risk factors. Comprehensive strategic initiatives are urgently needed to control obesity in the high-risk populations in the Emirate of Dubai.

Effect of Different Definitive Impression Techniques for Resorbed Mandibular Ridge on Retention of a Lower Complete Denture.

AIM: This study aimed to evaluate the effect of different definitive impression techniques for the resorbed mandibular ridge on the retention of lower complete dentures. MATERIALS AND METHODS: Ten completely edentulous male patients with severe atrophic mandibular ridge were selected from the Prosthodontic Department's outpatient clinic, Faculty of Dentistry, Sinai University (Kantara branch). Each patient received four dentures. Dentures were divided into four groups according to the type of final impression, Group I: Conventional impression techniques (open mouth technique), Group II: Cocktail impression techniques, Group III: Modified functional impression technique, and Group IV: Wire impression technique. Each denture was used for one month and at the end of the month the retention test was carried out and the results were tabulated and statistically analyzed. RESULTS: There is a statistically significant difference between the groups. The results also showed that the highest mean value was in group IV, whereas the lowest mean value of retention was in group I. CONCLUSION: Wire impressions produce lower dentures with higher retention, whereas conventional impressions produce lower dentures with the lowest retention, so it is considered to be more advantageous. CLINICAL SIGNIFICANCE: The wire impression technique is superior in the management of resorbed ridges as compared with other techniques.

Impact of COVID-19 pandemic on the mental health of university students in the United Arab Emirates: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic had a significant impact on the mental well-being of students worldwide. There is a scarcity of information on the mental health impact of the COVID-19 pandemic on university students in the United Arab Emirates (UAE). This study aimed to investigate the mental health impact of the COVID-19, including depression, anxiety and resilience among a sample of university students in the UAE. METHODS: A cross-sectional study using an online survey was conducted from September to November 2021. The patient health questionnaire (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC-10) were used to assess depression, anxiety, and resilience. The COVID-19 impact was assessed using a list of questions. RESULTS: Only, 798 students completed the survey and were analyzed for this study. Overall, 74.8% of the students were females, 91.2% were never married, and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), four out of ten of the students self-reported moderate to severe depression (40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores were found among students who were impacted by COVID-19 than those non-impacted (mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students who were impacted by COVID-19 had statistically significant higher depression and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017). CONCLUSIONS: The results of this study demonstrate that the COVID-19 pandemic has negatively impacted the mental health of this sample of university students in terms of depression and anxiety. The results highlight the need to adopt culturally appropriate interventions for university students and focus on vulnerable groups.

Geological and engineering appraisal of hydraulic frac sand in some Egyptian localities as a proppant of oil well drilling.

Sand that comprises high purity silica grains, in large percent, is of the best naturally occurring grains that can be used as proppants during hydraulic fracturing processes. Proppants are used to increase formations' permeability; to increase reservoirs' productivity, or to reopen plays and utilize unconventional reservoirs. The potentiality of these grains to be used as frac proppants is determined according to certain physical, mechanical, petrographical and chemical evaluations that include particle size analysis, acid solubility, turbidity, bulk density, crush resistance and hardness, sphericity and roundness, mineral and chemical composition. This study shows the evaluation of the silica sand samples collected from Malha Formation in Wadi El Dakhal, Eastern Desert; Naqus Formation in Wadi Qena, Eastern Desert; and Bahariya Formation at Gabal El-Dist area in Bahariya Oasis, Western Desert, Egypt. The samples were examined according to frac sand international standards. The results showed the potentiality of the tested samples to be utilized as frac sand proppants. Wadi El-Dakhal and Wadi Qena studied areas possess very promising samples for frac sand production. But, the quality of Wadi El-Dakhal samples is somewhat better than that of Wadi Qena samples. The samples of Gabal El-Dist in Bahariya Oasis are relatively less to achieve the requirements; however, they can be utilized in shallow depths. The assessment testing of the studied samples revealed a good results and verifying the standard requirements, where SiO2 content is 89.1% in Wadi Qena, 99.3 % in Wadi Dakhal and 78.1% in Gebel El Dist, crush resistance at 5000 psi gives fine percent 4.71 W.Q, 6.78 W.D, and 14.11 B.O, turbidity readings raining from 100.5 to 133.25 NTU, the grain roundness are rounded to sub rounded, and grain size distribution range is 30/50 to 40/70 grading (710 um to 210 um).

Prevalence and associated risk factors of hypertension and pre-hypertension among the adult population: findings from the Dubai Household Survey, 2019.

BACKGROUND: Minimal data is available on the prevalence and correlates of hypertension and prehypertension in Dubai. The study aims to measure the prevalence of hypertension and pre-hypertension and the associated socio-demographic characteristics, behavioral risk factors and comorbidities among the adult population of Dubai. METHODS: This study used data from the Dubai Household Health Survey, 2019. A cross-sectional population survey based on a complex stratified cluster random design. The total eligible sample included 2530 adults (18+). Sociodemographic and behavioral factors were considered as independent covariates. The main study outcome variables, pre-hypertension and hypertension, were ordinal, with normotension as the reference group. RESULTS: The overall prevalence of hypertension in adults was 32.5% (38.37% in males and 16.66% in females). Prehypertension was prevalent in 29.8% of adults in Dubai (28.85% in males and 32.31% in females). The multivariate logistic regression analysis revealed that age groups, gender, occupation, and high Body Mass Index were significantly associated with a higher risk of hypertension at the level of P < 0.05. No clear trend toward a higher correlation of hypertension was noted with the increase in age, except after the age of 50 years. Males were five- times more likely to be hypertensive than females. Participants enrolled in skilled and service works had a five times higher risk of hypertension, compared with the reference group (professionals). Obese subjects had a 5.47-times greater correlation of hypertension compared with normal-weight subjects. Physically active individuals were less likely to develop hypertension. For the correlates with prehypertension in the present analysis, skilled and service workers and those working in elementary jobs had a higher risk of prehypertension, compared with the reference group (professionals) Individuals with a status of overweight were associated with a higher prevalence of prehypertension compared with people of normal weight. CONCLUSIONS: This study showed a high prevalence of prehypertension and hypertension among adults in Dubai. Some socio-demographic and behavioral risk factors were correlated with prehypertension and hypertension among the studied population. Interventions aiming at increasing public awareness about such risk factors are essential.

The Socio-Demographic Characteristics Associated with Non-Communicable Diseases among the Adult Population of Dubai: Results from Dubai Household Survey 2019.

BACKGROUND: Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and the sociodemographic characteristics among the adult population of Dubai. METHODS: The study used secondary data from the Dubai Household Health Survey (DHHS), 2019. DHHS is a cross-sectional complex design, stratified by geographic area, and uses multistage probability sampling. In this survey, 2247 families were interviewed and only adults aged 18+ were included for the analysis. The quasi-binomial distribution was used to identify the socio-demographic characteristics association with NCDs. RESULTS: The prevalence of NCDs among the adult population of Dubai was 15.01%. Individuals aged 60+, local Arabs (Emirati), divorced and widowed individuals, and individuals who were not currently working reported NCDs more than the other groups. In the regression analysis, the association with NCDs were reported among elderly people, males, unmarried individuals, older individuals who are unmarried, and Emiratis. CONCLUSION: The study identified several socio-demographic characteristics associated with reporting NCDs. This is one of the few studies related to NCDs in Dubai. Allocating appropriate resources to the population groups identified is crucial to reduce the incidence of NCDs in the Emirate.

A hypertension risk score for adults: a population-based cross-sectional study from the Dubai Household Survey 2019.

OBJECTIVES: The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention. METHODS: A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations. RESULTS: A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9). CONCLUSIONS: The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.

Evaluation and characterization of some protective culture metabolites in free and nano-chitosan-loaded forms against common contaminants of Egyptian cheese.

This research attempted to inspect the contribution of lactic acid bacteria (LAB) with nanoparticle application in antimicrobial enhancement. Seven lactic acid cultures-free supernatants (CFSs) in both free and nanoparticles-loaded states were examined against seven foodborne microorganisms. Lactobacillus helveticus followed by Lactobacillus Plantarum possessed considerable antimicrobial activity. Headspace GC-MS characterization of Lactobacillus helveticus CFS identified a mixture of antimicrobial and health-promoting compounds. Minimal inhibitory concentration (MIC) values for tested Gram-positive bacteria represented 50% of that for Gram-negative bacteria, 20% and 7.35% of those for fungus and yeast respectively. Nanoparticles were prepared through chitosan-tripolyphosphate nanoparticle formation giving nanospheres from in the range from 5 to 10 nm, and narrow size distribution. CFS-loaded chitosan nanoparticles (CS-NPs) significantly enhanced the overall inhibition zone diameter, as well as, the decline in MIC values for Salmonella enterica (50%) and Penicillium chrysogenum (12.5%) was observed. Lactobacillus helveticus CFS, however, displayed lower antimicrobial activity vs. nisin and natamycin, it has both antibacterial and antifungal promising activities.

The protective potential of selected lactic acid bacteria against the most common contaminants in various types of cheese in Egypt.

Dairy products, especially cheeses have a great nutritional value and a high consumption level around the world. Considering a widespread consumption of cheeses, there is a growing concern regarding safety and microbiological quality. The current study was designed to conduct a recent evaluation of cheeses microbiological quality. Sixty cheese samples from retailing Egyptian markets were analyzed on different selective microbiological media and 64 bacteria, 35 yeasts and 8 molds were isolated. Out of 60 samples; 26.6% were contaminated with Escherichia coli, 73.3% with Staphylococcus scuiri, 3.33% with Bacillus cereus, 1.66% with Salmonella enterica, and 1.66% with Pseudomonas aeruginosa. The presence of such microorganisms in cheeses referred to the wrong management in cheese manufacturing. These organisms are significant from public health view as they have been associated with the base of human food poisoning. Promising antagonistic behavior was observed using the tested lactic acid bacteria (LAB) either single or in combinations toward the undesired isolates. Lactobacillus helveticus CNRZ 32 (Lb. helveticus) was the most potent culture; recording ≥95% reduction in undesired microbial counts.

Sensitivity and specificity of the classification of psoriatic arthritis criteria in early psoriatic arthritis.

OBJECTIVE: To assess the sensitivity and specificity of the Classification of Psoriatic Arthritis (CASPAR) Study Group criteria in early psoriatic arthritis (PsA) and to compare them with the sensitivity and specificity of the Moll and Wright criteria. METHODS: The CASPAR Study Group criteria were applied to patients with early PsA (<24 months symptom duration) and to control patients with other new-onset inflammatory arthritides. Both groups were naive to all disease-modifying antirheumatic drugs. The gold standard diagnosis was confirmed by the consulting rheumatologist using radiography and magnetic resonance imaging where required. Proportions of patients and control patients meeting the criteria were compared using McNemar's tests. RESULTS: We recruited a total of 111 patients with early PsA and 111 control patients with other forms of inflammatory arthritis (82 with rheumatoid arthritis, 13 with undifferentiated arthritis, 9 with spondylarthritis, 4 with inflammatory osteoarthritis, and 3 with crystal arthritis) to the study. The sensitivity of the CASPAR Study Group criteria in classifying early PsA was 87.4% compared to 80.2% for the Moll and Wright criteria. The specificity for both criteria was 99.1%. When considering different cut points for the CASPAR Study Group criteria, the best cut point for classification remained a score of ≥ 3 as in the original CASPAR Study Group analysis. Considering a score of ≥ 2 gave a higher sensitivity of 99.1% but resulted in a drop in specificity to 94.6%. Regression analysis determined that psoriasis and rheumatoid factor negativity were the most important features that differentiated PsA, followed by nail psoriasis and current or previous dactylitis. CONCLUSION: The CASPAR Study Group criteria are more sensitive than the Moll and Wright criteria in classifying early PsA. Although their sensitivity for early PsA is lower than that for established disease, the CASPAR Study Group criteria are valid for use as inclusion criteria for trials in early PsA.

The composite DAS Score is impractical to use in daily practice: evidence that physicians use the objective component of the DAS in decision making.

INTRODUCTION AND BACKGROUND: The disease activity score for 28 joints (DAS28) is widely used for assessing disease activity in rheumatoid arthritis and its use is recommended for establishing the need for anti- tumor necrosis factor drugs, according to British Society for Rheumatology guidelines. However, calculation of the score requires a laboratory measurement of inflammation (either erythrocyte sedimentation rate or C-reactive protein) so that it is not possible to have the actual score when the patient seen in the clinic and, therefore, it is not possible to make immediate treatment decisions based on the DAS28 score. METHODS: This is an audit of clinic-based treatment decisions, collecting data for the DAS28 on consecutive patients with rheumatoid arthritis. The nonlaboratory elements of the DAS score were completed along with a physician global assessment and any treatment decisions were recorded. RESULTS: Data on 100 patients were collected. Even when the patients were judged to have active disease by DAS28 treatment switches or increases were not always made. In logistic regression analyses, using treatment increase or switch as the dependent variable, only the swollen joint count was significant. CONCLUSION: There is evidence from this study that the DAS score is limited in daily clinical practice. In this audit of practice treatment, changes seem to be made on objective physician assessments rather than patient recorded assessments.

Mutations in 15-hydroxyprostaglandin dehydrogenase cause primary hypertrophic osteoarthropathy.

Digital clubbing, recognized by Hippocrates in the fifth century BC, is the outward hallmark of pulmonary hypertrophic osteoarthropathy, a clinical constellation that develops secondary to various acquired diseases, especially intrathoracic neoplasm. The pathogenesis of clubbing and hypertrophic osteoarthropathy has hitherto been poorly understood, but a clinically indistinguishable primary (idiopathic) form of hypertrophic osteoarthropathy (PHO) is recognized. This familial disorder can cause diagnostic confusion, as well as significant disability. By autozygosity methods, we mapped PHO to chromosome 4q33-q34 and identified mutations in HPGD, encoding 15-hydroxyprostaglandin dehydrogenase, the main enzyme of prostaglandin degradation. Homozygous individuals develop PHO secondary to chronically elevated prostaglandin E(2) levels. Heterozygous relatives also show milder biochemical and clinical manifestations. These findings not only suggest therapies for PHO, but also imply that clubbing secondary to other pathologies may be prostaglandin mediated. Testing for HPGD mutations and biochemical testing for HPGD deficiency in patients with unexplained clubbing might help to obviate extensive searches for occult pathology.

Development of an assessment tool for dactylitis in patients with psoriatic arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is characterized by inflammatory arthritis in the presence of psoriasis. Certain clinical features help characterize this disorder, one of which is dactylitis. Hitherto an instrument for quantifying dactylitis has not been developed. METHODS: A dactylitis score sheet was developed. The score is a function of finger circumference and tenderness, assessed and summed across all dactylitic digits. Initial results were obtained on a small sample of patients attending clinics. Inter and intraobserver agreement on the presence of dactylitis using kappa agreement statistics, and the validity and reliability of the instrument, using intraclass correlation coefficients (ICC), were assessed in a further group of 7 patients with PsA. RESULTS: Tender dactylitis was deemed present in 74 digits out of a total of 280 (140 digits on each occasion). Kappa agreement scores for the presence of tender dactylitis were poor to good, both within and between observers (0.25 to 0.89 between observers and 0.29 to 0.91 within observers). Agreement scores for non-tender dactylitis were poor (0.01 to 0.66 between observers and 0.01 to 0.59 within-observer agreement). The new dactylitis instrument was simple and easy to administer and was found to measure appropriate scores in patients with different severity of dactylitis. Inter and intraobserver agreement was good (interobserver ICC 0.90, 95% CI 0.74-0.98; intraobserver ICC 0.84, 95% CI 0.71-0.92). Intraobserver ICC improved but interobserver ICC deteriorated by rating simply presence or absence, rather than a 4 point grade, of tenderness. CONCLUSION: A new method for quantifying dactylitis based on digital circumference and tenderness has been described. This instrument has shown good inter and intraobserver reliability. Further studies of responsiveness are now required.