Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity

Pediatric Rheumatology Online Journal
Katherine S L TuttlePeter A Nigrovic

Abstract

Imaging of dactylitis in adult psoriatic arthritis suggests a pathophysiological role for enthesitis. However, histological definition of the dactylitic digit is unavailable. We evaluated the role of enthesitis in dactylitis associated with psoriatic juvenile idiopathic arthritis (psJIA) in a child who underwent detailed imaging and histologic evaluation. Radiographs, ultrasound and high-resolution magnetic resonance imaging were employed to define the locus of disease in two dactylitic digits from a 14-year-old girl with psJIA. Biopsies were stained with hematoxylin and eosin, CD3, CD20, CD4, CD8 and CD117 and examined via light microscopy. Radiologic features of dactylitis included enhanced signal at digital entheses without accompanying synovitis or tenosynovitis. Histologically, finger and toe tissue exhibited hypervascular tenosynovium with a fibromyxoid expansion of fibrous tissue. This was accompanied by sparse to moderate perivascular lymphocytic inflammation consisting predominantly of T cells, with occasional admixed B cells and mast cells. Neutrophils and plasma cells were absent. Fibrocartilage exhibited reactive features including increased extracellular myxoid matrix, binucleation, and focal necrosis, without cell...Continue Reading

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Citations

Oct 18, 2015·Rheumatic Diseases Clinics of North America·Alexis Ogdie, Pamela Weiss
Feb 6, 2017·The Journal of Rheumatology·Devy ZismanUNKNOWN CARRA Legacy Registry Investigators
Jan 3, 2016·The Journal of Rheumatology·Ai Lyn Tan, Dennis McGonagle
Jul 21, 2017·RMD Open·Séverine Guillaume-CzitromEllen Nordal
May 31, 2019·Minerva medica·Marta PrioraEnrico Fusaro
Oct 13, 2017·Arthritis & Rheumatology·Peter A NigrovicSusan D Thompson
Jan 6, 2019·Nature Reviews. Rheumatology·Dennis McGonaglePhilip Helliwell
Oct 30, 2018·Current Rheumatology Reports·Lihi Eder, Sibel Zehra Aydin
Mar 8, 2019·JCI Insight·Margaret H Chang, Peter A Nigrovic
Apr 8, 2020·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Masahiro TadaLew C Schon
Apr 2, 2020·Clinical Immunology : the Official Journal of the Clinical Immunology Society·Matthew L Stoll, Elizabeth D Mellins
Mar 19, 2021·Nature Reviews. Rheumatology·Peter A NigrovicAlberto Martini
Jun 12, 2021·Rheumatology·Aurivan E DantasGustavo G Resende

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Methods Mentioned

BETA
light microscopy
biopsy
biopsies

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