Enthesitis, Dactylitis, and Nail Disease Are Highly Prevalent in Psoriatic Arthritis

Hands with PsA
Hands of person with psoriatic arthritis.
Researchers described the prevalence of extra-articular manifestations, including enthesitis, dactylitis, and nail disease, in psoriatic arthritis, and their effect on longitudinal disease outcomes.

Enthesitis, dactylitis, and nail disease are highly prevalent in patients with psoriatic arthritis (PsA), according to results of a systematic review and meta-analysis published in Rheumatology.

Extra-articular manifestations in PsA may help inform disease diagnosis, classification, and management. Researchers performed a systematic review to determine the prevalence of extra-articular manifestations in PsA and their effect on outcomes.

Investigators performed a literature search of the Medline, PubMed, Scopus, and Web of Science databases for literature related to PsA and various extra-articular manifestations available through September 2019. References were manually searched for additional relevant literature. Extra-articular manifestations included in the analysis were enthesitis, dactylitis, nail disease, uveitis, and inflammatory bowel disease (Crohn disease and ulcerative colitis).

Of the 9493 publications identified in the search, 65 studies were included in the analysis. Sample sizes ranged from 31 to 94,302 patients, for a pooled total of 163,299 patients with PsA.

Enthesitis, dactylitis, and nail disease were assessed in 29, 35, and 26 studies, respectively, and occurred at a high prevalence. The pooled estimates were 30% (95% CI, 24%-38%), 25% (95% CI, 20%-31%), and 60% (95% CI, 52%-68%), respectively. Uveitis and inflammatory bowel disease were reported in 21 and 8 studies, respectively, and occurred less frequently. The pooled estimate was 3.2% for uveitis (95% CI, 1.9%-5.3%) and 3.3% for inflammatory bowel disease (95% CI, 1.5%-7.1%).

Related Articles

The heterogeneity was high (>95%) in all analyses, but could not be explained by study characteristics such as age, sex, year of publication, or geography. No studies examined the effect of extra-articular manifestations on patient outcomes.

Researchers noted that the heterogeneous definitions of extra-articular manifestations were a limitation of the review. In addition, disease severity with relation to the extra-articular manifestations could not be examined.

“Enthesitis, dactylitis and nail disease are highly prevalent in PsA, but not uveitis and [inflammatory bowel disease],” the study authors concluded. “Further studies should focus on whether [extra-articular manifestations] influence long-term outcomes in patients [with] PsA.”


Pittam B, Gupta S, Harrison NL, Robertson S, Hughes DM, Zhao SS. Prevalence of extra-articular manifestations in psoriatic arthritis: a systematic review and meta-analysis [published online March 11, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa062