Pathophysiology, assessment and treatment of psoriatic dactylitis

Dennis McGonagle*, Ai Lyn Tan, Abdulla Watad, Philip Helliwell

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Dactylitis is diffuse swelling of the digits that is usually related to an underlying inflammatory or infiltrative disorder. Psoriatic arthritis (PsA) is the most common severe disease thought to cause dactylitis. Our understanding of the pathogenesis of PsA-related dactylitis comes from experimental animal models of PsA-like disease, as well as advances in imaging and other clinical studies. Clinical trials in PsA have increasingly included dactylitis as an important secondary outcome measure. These studies indicate that cytokines drive multi-locus microanatomical pan-digital pathology. Given the importance of pro-inflammatory cytokines, the pathogenesis of dactylitis is best understood as an initial aberrant innate immune response to biomechanical stress or injury, with subsequent adaptive immune mechanisms amplifying the dactylitis inflammatory response. Regarding the treatment of dactylitis, no studies have been conducted using dactylitis as the primary outcome measure, and the current knowledge comes from analysis of dactylitis as a secondary outcome measure.

Original languageEnglish
Pages (from-to)113-122
Number of pages10
JournalNature reviews. Rheumatology
Issue number2
StatePublished - 1 Feb 2019


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