Local steroid injections are associated with clinically meaningful improvements in active dactylitis in patients with psoriatic arthritis (PsA), according to the results of a multicenter study published in Clinical Rheumatology.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and local corticosteroid injections are currently recommended for the treatment of dactylitis in patients with PsA; however, there is very little information on the efficacy of local corticosteroid injections. In an observational prospective study, investigators aimed to compare the efficacy of local steroid injections and NSAIDs on the digital flexor tendon sheath for the treatment of active dactylitis in patients with PsA.
The Leeds Dactylitis Index basic (LDI-b) score was calculated at baseline, with patients rating their local pain intensity and functional impairment on 10 cm scales for each involved digit. Assessments were repeated at 1 and 3 months, postprocedure. Researchers recorded the presence of local or systemic events at each examination.
The primary objective of interest was a clinically meaningful treatment response, defined as the reduction of visual analog pain (VAS-pain) and functional impairment (VAS-FI) scores by ≥5 points or VAS-pain and VAS-FI scores <2. The secondary objective of interest was complete dactylitis remission (VAS-pain=0 and VAS-FI=0).
A total of 24 patients with 38 dactylic fingers were treated with steroid injections and 22 patients with 35 dactylic fingers were treated with NSAIDs. At baseline, there was no significant difference in VAS-pain score, finger circumference, or LDI-b between groups, though VAS-FI score was significantly higher in the steroid-treated group (7.87±1.53) than the NSAID-treated group (6.89±1.82; P =.018).
Significant improvements in clinical parameters were observed at 1 and 3 months in both groups; however, there were no improvements in VAS-pain scores at either time point in the NSAID-treated group. The reduction in VAS-pain (P <.001), VAS-FI (P <.001), and LDI-b values (P =.008) was greater in the steroid-treated group compared with the NSAID-treated group at 1 month. This trend continued at 3 months, post-treatment (P <.001 for all). A clinically meaningful treatment response was observed in 87% of dactylic fingers in the steroid-treated group compared with 17% in the NSAID-treated group (P <.001) at 1 month. This difference remained significant at 3 months as well. Complete remission was observed exclusively in the steroid-treated group in 1 and 7 cases at 1 and 3 months, respectively.
According to multiple regression analysis, the steroid injections were associated with a clinical response at both 1 (odds ratio [OR], 20.104; 95% CI, 2.481-162.9; P =.002) and 3 months (OR, 27.950; 95% CI, 3.227-142.1; P =.002), postprocedure.
Researchers noted that patients were given the choice to receive local steroid injections or NSAID treatment, and that the lack of randomization represented a limitation of the study. In addition, it was unclear what long-term maintenance may be needed to maintain the efficacy of steroid injections given the short duration of the study.
“[T]hese data support the use of steroid injections into the digital flexor tendon sheath for psoriatic dactylitis,” the researchers concluded. “[L]ocal steroid injection can be recommended as a safe and effective first-line therapy for psoriatic dactylitis.
Girolimetto N, Macchioni P, Citriniti G, et al. Effectiveness of steroid injection for hand psoriatic dactylitis: results from a multicentre prospective observational study [published online May 16, 2020]. Clin Rheumatol. doi:10.1007/s10067-020-05142-z