Skip to main content

Advertisement

Log in

The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis

  • Original Article
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Purpose

To investigate the frequency of thickening of pulleys for flexor tendons in patients with early arthritis in their hands, and to evaluate it as a predictive sign of PsA.

Methods

A prospective observational study involving 228 consecutive patients presenting with recent onset of arthritis in their hands was conducted at rheumatology outpatient clinics in the Veneto region of Italy between October 2014 and September 2017. Diabetic patients were excluded because of the high frequency of trigger finger. The final diagnosis of the rheumatologist delivered after 12 months of follow-up, was considered as the gold standard for the analysis of diagnostic accuracy.

Results

Twenty-two patients were excluded from the study because of diabetes. A total of 86 patients with thickening of A1 pulleys in flexor tendons and 120 without were evaluated. Pulley thickness was significantly associated with a family history of psoriasis (18/86 vs 3/120, p ˂ 0.001) and diabetes (9/86 vs 4/120, p = 0.036), and with a personal history of cutaneous psoriasis (25/86 vs 10/120, p ˂ 0.001), psoriatic onychopathy (7/86 vs 2/120, p = 0.028), lower back pain (22/86 vs 11/120, p = 0.001), Dupuytren’s disease (7/86 vs 2/120 p = 0.028) and De Quervain tenosynovitis (4/86 vs 0/120, p = 0.028). In isolation, this sign had a good sensitivity rate (80%). The specificity rate for the disease was barely significative (71%), with an LR+ of 2.71 for PsA.

Conclusions

The thickening of the pulleys in the flexor tendons is an easy-to-detect sign with good sensitivity for the diagnosis of PsA. Its specificity and positive predictive value are not very high; however, if it is included in a complete classification process, sonographers should report it during hand evaluations of patients with arthritis.

Sommario

Scopo

Studiare la frequenza di ispessimento delle pulegge tendinee A1 (A1P) dei muscoli flessori delle dita in pazienti affetti da artrite della mano in fase precoce e valutarlo come un segno predittivo di Artrite Psoriasica (AP).

Metodi

Uno studio prospettico osservazionale multicentrico su 228 pazienti ambulatoriali consecutivi che presentavano recente insorgenza di artrite alle mani tra ottobre 2014 e settembre 2017. I pazienti diabetici sono stati esclusi a causa dell’alta frequenza di dito a scatto. La diagnosi finale del Reumatologo Curante dopo un follow-up di 12 mesi è stata confrontata come Gold Standard.

Risultati

Un totale di 86 pazienti con ispessimento delle A1P e 120 senza sono stati arruolati. L’ispessimento delle A1P era significativamente associato a storia familiare di psoriasi (18/86 vs 3/120, p ˂ 0.001) e di diabete (9/86 vs 4/120, p = 0.036), con storia personale di psoriasi cutanea (25/86 vs 10/120, p ˂ 0.001), di onicopatia psoriasica (7/86 vs 2/120, p = 0,028), di lombalgia (22/86 vs 11/120, p = 0,001), di malattia di Dupuytren (7/86 vs 2/120 p = 0,028) e di tenosinovite di De Quervain (4/86 vs 0/120, p = 0,028). Isolato, questo segno ha dimostrato una buona sensibilità (80%) per la diagnosi di AP; la specificità per AP era appena significativa (71%) con una LR+ di 2,71.

Conclusioni

L’ispessimento delle A1P è facile da individuare con una buona sensibilità per la diagnosi di AP. La specificità e il VPP non erano molto elevati. Tuttavia, lo studio ecografico delle pulegge tendinee dovrebbe essere incluso nel processo diagnostico di pazienti con artrite acrale all’esordio.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rudwaleit M (2010) New approaches to diagnosis and classification of axial and peripheral spondyloarthritis. Curr Opin Rheumatol 22:375–380

    Article  Google Scholar 

  2. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  Google Scholar 

  3. Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D (2015) High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 74:185–189

    Article  Google Scholar 

  4. Tan AL (2006) Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis 65:1267–1272

    Article  CAS  Google Scholar 

  5. Lebiedz-Odrobina D, Kay J (2010) Rheumatic manifestations of diabetes mellitus. Rheum Dis Clin North Am. 36:681–699

    Article  Google Scholar 

  6. Kameyama M, Meguro S, Funae O, Atsumi Y, Ikegami H (2009) The presence of limited joint mobility is significantly associated with multiple digit involvement by stenosing flexor tenosynovitis in diabetics. J Rheumatol. 36:1686–1690

    Article  Google Scholar 

  7. Arkkila PET, Gautier J-F (2003) Musculoskeletal disorders in diabetes mellitus: an update. Best Pract Res Clin Rheumatol 17:945–970

    Article  CAS  Google Scholar 

  8. Miyamoto H, Miura T, Isayama H, Masuzaki R, Koike K, Ohe T (2011) Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am. 36:1486–1491

    Article  Google Scholar 

  9. Sato J, Ishii Y, Noguchi H, Takeda M (2012) Sonographic appearance of the flexor tendon, volar plate, and A1 pulley with respect to the severity of trigger finger. J Hand Surg Am. 37:2012–2020

    Article  Google Scholar 

  10. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649

    Article  CAS  Google Scholar 

  11. Filippucci E, Iagnocco A, Salaffi F, Cerioni A, Valesini G, Grassi W (2006) Power Doppler sonography monitoring of synovial perfusion at the wrist joints in patients with rheumatoid arthritis treated with adalimumab. Ann Rheum Dis 65:1433–1437

    Article  CAS  Google Scholar 

  12. Salaffi F, De Angelis R, Grassi W, Prevalence MAP, Study ING (2005) Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 23:819–828

    CAS  PubMed  Google Scholar 

  13. Tinazzi I, McGonagle D, Aydin SZ, Chessa D, Marchetta A, Macchioni P (2018) ‘Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann Rheum Dis 77:922–925

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonio Furlan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee at the University Hospital of Padua (Italy).

Informed consent

Every patient provided informed consent before enrollment.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Furlan, A., Stramare, R. The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis. J Ultrasound 21, 309–314 (2018). https://doi.org/10.1007/s40477-018-0325-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-018-0325-2

Keywords

Navigation