exploratory study to identify mechanical factors that may ...€¦ · foot; 2nd and 4th toes, and...
TRANSCRIPT
Exploratory study to identify
mechanical factors that may contribute to
toe dactylitis in patients with psoriatic arthritisRichard A Wilkins, Dr Heidi J Siddle, Prof. Anthony C Redmond, Dr Philip S Helliwell
BackgroundDactylitis (sausage digit) is one of the most
commonly reported features of psoriatic arthritis
(PsA) (Fig 1).
It has been hypothesised that dactylitis is a
functional enthesitis at the proximal
interphalangeal joints (hands and feet), resulting
in synovitis, tenosynovitis, bone and soft tissue
oedema to the digit.
Trauma and physical insult to the digit have been
suggested as a possible cause
Aim• To explore mechanical factors that may
contribute to the occurrence of dactylitis in
patients with PsA.
• To explore the impact of dactylitis on
impairment, function, activity and limitations.
• To provide insight into plantar pressure
distributions in PsA
Methods12 participants with PsA and a history of dactylitis
(group i), 12 participants with PsA and no history
of dactylitis (group ii), 12 control participants
(group iii) were recruited.
Plantar pressure measurements were undertaken
barefoot and in footwear.
Peak plantar pressure and pressure time integral
were analysed at the most common and second
most common sites of dactylitis reported in the
foot; 2nd and 4th toes, and 2nd and 4th meta-
tarsophalangeal joints (MTP) of the left foot (fig 2).
Temporal and spatial parameters of gait were
collected
Patient reported impairment and footwear
(FISAP), and activity limitation and participant
restriction (FISIF) were reported using the Foot
Impact Scale for Rheumatoid Arthritis (FIS-RA).
Results PsA patients in both groups had a mean
disease duration of 4.5 years
• Mean FIS-RAIF out of 21
- PsA Dactylitis 7.16
- PsA no history of dactylitis 6.83
- Controls 0.41
• Mean FIS-RAAP Out of 30
- PsA Dactylitis 8.75
- PsA no history of dactylitis 5.75
- Controls 0.16
ANOVA analysis and subsequent post-hoc
testing using Games-Howell test yielded
significance in FIS-RA mean scores.
No Significant difference in plantar
pressures or gait variables between
groups
Conclusions• This is the first exploratory study to
investigate the mechanical factors that
may cause dactylitis in PsA
• FIS-RA scores indicate PsA patients have
significant limitations compared to
controls, but a history of dactylitis does
not worsen patient reported outcomes.
• Although no significant differences
could be reported in plantar pressure
data or gait variables, the study was
underpowered.
• Exploration of shear and friction in the
forefoot may provide insight for a
biomechanical trigger to dactylitis.
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Figure 1; Dactylitis of the 3rd 4th and 5th toes
Figure 2; Plantar pressure with masking
Results