How Variable Is the Volar Subcutaneous Tissue of the Digits on B-Mode and Color Doppler Ultrasound in Non-Psoriatic Individuals and Could It Be Included in a Dactylitis Score?

Abstract

Background Digital subcutaneous tissue (SCT) changes are involved in dactylitis, a hallmark feature of psoriatic arthritis (PsA). There are no studies on the ultrasound (US) characteristics of the digital SCT in the general population.

Objectives To investigate the variability in US-measured thickness (TH) and color Doppler (CD)-detected blood flow of the SCT of the volar aspects of the fingers in a non-psoriatic population and to investigate the impact of the scanning method and demographics and clinical features on these measurements.

Methods SCT TH and semiquantitative (SQD) and quantitative (QD) Doppler signals were measured in the bilateral second finger at the proximal and middle phalanges in 81 non-psoriatic volunteers [49 female, 32 men; 18–78 years]. Two scanning methods with and without (thick gel layer interposition) probe-skin contact were used. Demographics and clinical features were collected.

Results There was high variability of SCT TH and Doppler measurements between individuals. All US measurements obtained without probe-skin contact were significantly greater than their corresponding measurements obtained with the probe contacting the skin (p < 0.001). SCT TH was positively related to dominant hand, age, masculine gender, weight, height, body mass index, and alcohol consumption while Doppler measurements were positively related to age and non-dominant hand.

Conclusions US-measured SCT thickness and Doppler-detected SCT blood flow of the volar aspect of the fingers seem to be highly variable in the non-psoriatic population as well as highly dependent on the US scanning method. This variability is of utmost importance for assessing dactylitis in PsA.

Zusammenfassung

Hintergrund Veränderungen des subkutanen Gewebes (subcutaneous tissue, SCT) der Finger sind an der Daktylitis beteiligt, einem charakteristischen Zeichen der Psoriasis-Arthritis (PsA). Es gibt keine Studien über die Ultraschall (US) -Merkmale des digitalen SCT in der Allgemeinbevölkerung.

Ziel Untersuchung der Variabilität der im US gemessenen Dicke (TH) und des mit Farbdoppler (CD) gemessenen Blutflusses des SCT der volaren Seiten der Finger in einer nicht psoriatischen Population sowie die Untersuchung des Einflusses der Untersuchungsmethode und demografischer und klinischer Parameter auf diese Messungen.

Methoden SCT-TH und semiquantitative (SQD) und quantitative (QD) Dopplersignale wurden bilateral am zweiten Finger an den proximalen und mittleren Fingergliedern bei 81 nicht psoriatischen Freiwilligen (49 weiblich, 32 männlich; 18–78 Jahre) bestimmt. Es wurden 2 Untersuchungsmethoden verwendet: 1 eine mit Sonden-Haut-Kontakt sowie eine ohne (durch Einfügen einer dicken Gelschicht). Demografische und klinische Merkmale wurden erhoben.

Ergebnisse Es gab eine hohe Variabilität der SCT-TH- und Doppler-Messungen zwischen den Individuen. Alle US-Messungen ohne Sonden-Haut-Kontakt waren signifikant größer als die entsprechenden Messungen, die mit Sonden-Haut-Kontakt durchgeführt wurden (p < 0,001). Es gab eine positive Relation der SCT-TH mit der dominanten Hand, dem Alter, dem männlichen Geschlecht, dem Gewicht, der Größe, dem Body-Mass-Index und dem Alkoholkonsum, während die Doppler-Messungen eine positive Relation zum Alter und der nicht dominanten Hand aufwiesen.

Schlussfolgerungen Die im US gemessene SCT-Dicke und der im Doppler detektierte SCT-Blutfluss der volaren Seiten der Finger scheinen in der nicht psoriatischen Bevölkerung sehr variabel zu sein und hängen stark von der US-Untersuchungsmethode ab. Diese Variabilität ist für die Beurteilung der Daktylitis bei PsA von größter Bedeutung.

Key words

point of care - dactylitis - digital subcutaneous tissue - education - training - quality assurance - musculoskeletal system

Publication History

Received: 30 October 2019

Accepted: 13 April 2020

Article published online:
20 May 2020

• References

• 1 Gladman DD, Antoni C, Mease P. et al Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 (Suppl. 02) ii14-ii17
• 2 Veale D, Rogers S, Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol 1994; 33: 133-138
• 3 Brockbank JE, Stein M, Schentag CT. et al Dactylitis in psoriatic arthritis: a marker for disease severity?. Ann Rheum Dis 2005; 64: 188-190
• 4 Olivieri I, Barozzi L, Favaro L. et al Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum 1996; 39: 1524-1528
• 5 Kane D, Greaney T, Bresnihan B. et al Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 1999; 26: 1746-1751
• 6 Wakefield RJ, Emery P, Veale D. Ultrasonography and psoriatic arthritis. J Rheumatol 2000; 27: 1564-1565
• 7 Fournié B, Margarit-Coll N, Champetier de Ribes TL. et al Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine 2006; 73: 527-531
• 8 McGonagle D, Lories RJ, Tan AL. et al The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007; 56: 2482-2491
• 9 Gutierrez M, Filippucci E, Salaffi F. et al Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: The value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 2011; 70: 1111-1114 . doi:10.1136/ard.2010.147272
• 10 Aydin SZ, Castillo-Gallego C, Ash ZR. et al Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy. Dermatology 2012; 225: 231-235 . doi:10.1159/000343607
• 11 Filippou G, Di Sabatino V, Adinolfi A. et al No enthesis should be overlooked when psoriatic arthritis is suspected: Enthesitis of the extensor digitorum tendons. J Rheumatol 2013; 40: 335 . doi:10.3899/jrheum.121123
• 12 Bakewell CJ, Olivieri I, Aydin SZ. et al Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. J Rheumatol 2013; 40: 1951-1957 . doi:10.3899/jrheum.130643
• 13 Terslev L, Naredo E, Iagnocco A. et al Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res 2014; 66: 741-748 . doi:10.1002/acr.22191
• 14 Tan AL, Fukuba E, Halliday NA. et al High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 2015; 74: 185-189 . doi10.1136/annrheumdis-2014-205839
• 15 Zabotti A, Salvin S, Quartuccio L. et al Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands. Clin Exp Rheumatol 2016; 34: 459-465
• 16 Zabotti A, Idolazzi L, Batticciotto A. et al Enthesitis of the hands in psoriatic arthritis: an ultrasonographic perspective. Med Ultrason 2017; 4: 438-443 . doi:10.11152/mu-1172
• 17 Zabotti A, Bandinelli F, Batticciotto A. et al Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 2017; 56: 1518-1532 . doi:0.1093/rheumatology/kex179
• 18 Østergaard M, Eder L, Christiansen SN. et al Imaging in the diagnosis and management of peripheral psoriatic arthritis-The clinical utility of magnetic resonance imaging and ultrasonography. Best Pract Res Clin Rheumatol 2016; 30: 624-637 . doi:10.1016/j.berh.2016.08.012
• 19 Zabotti A, Errichetti E, Zuliani F. et al Early psoriatic arthritis versus early seronegative rheumatoid arthritis: role of dermoscopy combined with ultrasonography for differential diagnosis. J Rheumatol 2018; 45: 648-654 . doi:10.3899/jrheum.170962
• 20 Tinazzi I, Mcgonagle D, Zabotti A. et al Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin Exp Rheumatol 2018; 36: 785-790
• 21 Girolimetto N, Macchioni P, Tinazzi I. et al Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. Clin Rheumatol 2019; DOI: 10.1007/s10067-019-04683-2.
• 22 Girolimetto N, Costa L, Mancarella L. et al Symptomatic psoriatic dactylitis is associated with ultrasound determined extra-synovial inflammatory features and shorter disease duration. Clin Rheumatol 2019; 38: 903-911 . doi:10.1007/s10067-018-4400-z
• 23 Kaeley GS, Eder L, Aydin SZ. et al Dactylitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018; 48: 263-273 . doi:10.1016/j.semarthrit.2018.02.002
• 24 Bruyn GA, Iagnocco A, Naredo E. OMERACT Ultrasound Working Group. et al OMERACT Definitions for Ultrasonographic Pathology and Elementary Lesions of Rheumatic Disorders 15 Years On. J Rheumatol 2019; 46: 1388-1393 . doi:10.3899/jrheum.181095
• 25 Naredo E, D’Agostino MA, Wakefield RJ. et al Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 2013; 72: 1328-1334 . doi:10.1136/annrheumdis-2012-202092
• 26 D'Agostino MA, Terslev L, Aegerter P. et al Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 2017; 3: e000428 . doi:10.1136/rmdopen-2016-000428
• 27 Voche P, Merle M. Vascular supply of the palmar subcutaneous tissue of fingers. Br J Plast Surg 1996; 49: 315-318
• 28 Bianchi S, Martinoli C, de Gautard R. et al Ultrasound of the digital flexor system: Normal and pathological findings. J Ultrasound 2007; 10: 85-92 . doi:10.1016/j.jus.2007.03.002
• 29 Lee SA, Kim BH, Kim SJ. et al Current status of ultrasonography of the finger. Ultrasonography 2016; 35: 110-123 . doi:10.14366/usg.15051
• 30 Möller I, Janta I, Backhaus M. et al The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 2017; 76: 1974-1979 . doi:10.1136/annrheumdis-2017-211585