THU0372 EFFECTIVENESS OF STEROID INJECTION FOR HAND PSORIATIC DACTYLITIS: RESULTS FROM A MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY.
Authors: N. Girolimetto, G. Citriniti, I. Tinazzi, P. Macchioni
Journal: Annals of the Rheumatic Diseases (2020)

Background: Dactylitis is a common feature of PsA, occurring in 16 to 49% of PsA patients, mostly in early disease. Objectives: To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath for the treatment of active dactylitis in PsA patients as compared to systemic treatment (ST) alone. Methods: 73 hand dactylitis were assessed in a prospective observational study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for pain (VAS pain), functional impairment (VAS-FI). In accordance with EULAR and GRAPPA recommendations, steroid injection was proposed to all patients. Patients who refused LT were treated with oral NSAIDs. The patients of the two groups continued baseline therapy with csDMARDs or corticosteroids. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3) by assessors blinded to this study. Results: The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group as compared to the ST group, both at T1 (p &lt;0.001, p&lt;0.001 and p=0.008, respectively) and at T3 (p&lt;0.001, p&lt;0.001 and p&lt;0.001, respectively) (see Table 1). A clinically meaningful treatment response was observed at T1 in 33 (87%) digits in LT group and in 6 (17%) digits in ST group (p &lt; 0.001). At T3, clinical response improved significantly in both the groups, with significant difference (see Table 2). In both the groups, no local and systemic adverse events were observed during the follow up period. Table 1. Variation of clinical parameters during follow up. T0 baseline T1 1 month T3 3 months T0 vs T1 95% CI T0 vs T3 95% CI VAS - PAIN LT 6.89±1.93 1.97±1.62 1.34±1.48 4.92 ( 4.17; 5.67 ) 5.55 (4.76; 6.32 ) ST 6.03±2.43 5.49±2.53 5.0±2.65 0.54 (-0.23;1.32) 1.03 (-0.02; 2.07) Mean differences (95% CI ) 0.87 (-1.89; 0.16) 3.51 (2.53; 4.49 ) 3.66 (2.67; 4.65 ) VAS - FI LT 7.87±1.53 2.76±1.87 1.68±1.54 5.11 (4.49; 5.72 ) 6.18 (5.52; 6.84 ) ST 6.89±1.92 6.14±2.25 5.74±2.63 0.74 (0.23; 1.26 ) 1.14 (0.32; 1.97 ) Mean differences (95%CI) 0.98 (-1,79; 0,17 ) 3.38 (2.42; 4.34 ) 4.05 (3.06; 5.05 ) Finger circumference (cm) LT 7.17±0.57 6.61±0.59 6.55±0.54 0.56 (0.46; 0.65 ) 0.62 (0.52; 0.73 ) ST 7.05±0.80 6.90±0.89 6.88±0.91 0.15 (0.06; 0.25 ) 0.17 (0.07; 0.27 ) Mean differences (95%CI) 0.12 (-0.44; 0.21) 0.29 (-0.07 – 0.69) 0.33 (-0.02 -0.68) LDI-b LT 12.31±0.03 9.91±7.15 1.25±4.35 8.40 (5.73;11.06 ) 11.05 (8.22; 13.89 ) ST 14.97±11.07 9.88±10.98 10.04±11.09 5.10 (1.63; 8.55 ) 4.93 (1.54; 8.32 ) Mean differences (95%CI) 2.67 (-1.82; 7.16) 5.97 (1.58; 10.35 ) 8.79 (4.74;12.83 ) VAS, visual analogue scale; VAS-FI, Visual analogue scale for functional impairment; LDI-b, Leed’s dactylitic index basic; LT, local treatment group; ST, systemic treatment group. Table 2. Percentage of Significant response and Remission of dactylitis. T1 1 month T3 3 months Significant response, n (%) LT 33 (86.8%) 36 (94.7%) ST 6 (17.1%) 11 (31.4%) p value &lt; 0.001 &lt; 0.001 Remission n (%) LT 1 (2.8%) 7 (18.4%) ST 0 (0%) 0 (0%) p value ns 0.012 Values are presented as number of dactylitic fingers achieving response/remission. p values &lt; 0.05 were considered statistically significant. Conclusion: For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects and symptoms of hand psoriatic dactylitis. References: [1]Gladman DD, Ziouzina O, Thavaneswaran A, Chandran V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J Rheumatol. 2013;40:1357-9. Disclosure of Interests: None declared