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Novel and reliable DACTylitis glObal Sonographic (DACTOS) score in psoriatic arthritis
  1. Alen Zabotti1,
  2. Garifallia Sakellariou2,
  3. Ilaria Tinazzi3,
  4. Luca Idolazzi4,
  5. Alberto Batticciotto5,
  6. Marco Canzoni6,
  7. Greta Carrara7,
  8. Orazio De Lucia8,
  9. Fabiana Figus9,
  10. Nicolò Girolimetto10,
  11. Pierluigi Macchioni10,
  12. Rebecca McConnell11,
  13. Niccolò Possemato10,
  14. Annamaria Iagnocco9
  1. 1 Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
  2. 2 Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  3. 3 Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
  4. 4 Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
  5. 5 Department of Internal Medicine, Rheumatology Unit, ASST-Settelaghi. “Ospedale di Circolo – Fondazione Macchi”, Varese, Italy
  6. 6 Primary Care Department, Local Health Unit (ASL), Rome -1, Rome-4 and Viterbo, Rome, Italy
  7. 7 Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
  8. 8 Rheumatology and Orthopedic Department, ASST-Gaetano Pini/CTO Orthopedic and Traumatology Specialist Center, Milan, Italy
  9. 9 Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, MFRU, Turin, Italy
  10. 10 Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  11. 11 Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
  1. Correspondence to Professor Annamaria Iagnocco, Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin 10043, Italy; annamaria.iagnocco1{at}


Objectives Dactylitis is one of the most typical features of psoriatic arthritis (PsA), with a high lifetime prevalence and inclusion in PsA clinical indices. Musculoskeletal ultrasonography (Msk-US) can readily detect inflammatory involvement of finger anatomical structures particular to dactylitis and monitor therapeutic effects. In this study, we aim to identify the characteristic lesions in PsA dactylitis of the hands, assess the reliability of Msk-US in scoring those lesions and develop a DACTylitis glObal Sonographic (DACTOS) score.

Methods After a systematic literature review on the use of Msk-US in PsA dactylitis, 12 rheumatologists participated in a three-round Delphi procedure and consensus meeting to agree on the sonographic elementary lesions characterising dactylitis and on the composition of a global sonographic score. Then, a web-based and a patient-based intra-rater and inter-rater reliability exercise was performed to assess those lesions included in the score.

Results DACTOS score was obtained by summing the scores of each lesion selected in the Delphi survey: subcutaneous soft tissue oedema, flexor tenosynovitis, peritendon extensor inflammation and synovitis. The DACTOS score ranges from 0 to 25. In the reliability exercises, we obtained moderate-to-excellent agreement for the sonographic lesions included in the score.

Conclusions The novel DACTOS score is a reliable measure to interpret the multiple characteristic sonographic features of dactylitis. The DACTOS score provides a useful global analysis of dactylitis of the hand and can represent a support to clinical diagnosis as well as a useful tool for the management and research in patients with PsA with dactylitis.

  • psoriatic arthritis
  • spondyloarthritis
  • ultrasonography

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  • Handling editor Josef S Smolen

  • AZ and GS contributed equally.

  • Contributors All authors were involved in drafting, revising and approved the final version of the manuscript. Substantial contributions for study conception and design were made by all authors; AZ, GS, GC and AI for data analysis; all authors for the acquisition of study data and for data interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The live exercise was approved by the Local Ethics Committee (Reggio Emilia, Italy).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or in the supplementary files. Other data are available on reasonable request.