The following is a summary of the “Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations,” published in the February 2023 issue of Rheumatology by Palominos, et al.

This literature review aimed to determine the most effective treatments currently available for dactylitis and provide the most recent scientific evidence to back up the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations for the management of psoriatic arthritis. Primary articles were published in MEDLINE, Embase, and the Cochrane Library between 2013 and 2020 that described interventional trials and reported outcomes related to dactylitis. 

A standardized data extraction form was used to categorize the GRAPPA dactylitis group’s 20 participants into 9 treatment-based subgroups, with members of each subgroup then extracting data independently from the articles and abstracts that pertained to their subgroup. There were 16,752 patients drawn from 49 publications, representing 40 randomized clinical trials (RCTs). More than 40% of RCTs did not use a specific dactylitis measure or instrument, and in 97.5% of these trials, dactylitis assessment was a secondary outcome.

The treatment options for dactylitis have greatly increased with the development of agents with novel mechanisms of action, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, in recent years. This article highlights the need for more agreement on evaluating dactylitis and more information on the effectiveness of local steroid injections, nonsteroidal anti-inflammatory drugs, and traditional disease-modifying antirheumatic drugs. In addition, clinical trials should be encouraged to understand better the efficacy of these inexpensive and time-tested treatments for dactylitis.

Source: jrheum.org/content/50/2/265