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

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• 作者：Katherine SL Tuttle (1)
  Sara O Vargas (2)
  Michael J Callahan (3)
  Donald S Bae (4)
  Peter A Nigrovic (1) (5)
  
  1. Division of Immunology ; Boston Children鈥檚 Hospital ; Boston ; MA ; USA
  2. Department of Pathology ; Boston Children鈥檚 Hospital ; Boston ; MA ; USA
  3. Department of Radiology ; Boston Children鈥檚 Hospital ; Boston ; MA ; USA
  4. Department of Orthopedic Surgery ; Boston Children鈥檚 Hospital ; Boston ; MA ; USA
  5. Division of Rheumatology ; Immunology ; and Allergy ; Brigham and Women鈥檚 Hospital ; Smith 516B ; One Jimmy Fund Way ; Boston ; MA ; 02115 ; USA
  
• 关键词：Psoriatic arthritis ; Juvenile idiopathic arthritis ; Psoriatic juvenile idiopathic arthritis ; Enthesitis ; Enthesitis related arthritis ; Dactylitis
• 刊名：Pediatric Rheumatology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：13
• 期：1
• 全文大小：2,983 KB
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  8. Tsitsami, E, Bozzola, E, Magni-Manzoni, S, Viola, S, Pistorio, A, Ruperto, N (2003) Positive family history of psoriasis does not affect the clinical expression and course of juvenile idiopathic arthritis patients with oligoarthritis. Arthritis Rheum 49: pp. 488-93 CrossRef
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  13. Butbul, YA, Tyrrell, PN, Schneider, R, Dhillon, S, Feldman, BM, Laxer, RM (2009) Comparison of patients with juvenile psoriatic arthritis and nonpsoriatic juvenile idiopathic arthritis: how different are they?. J Rheumatol 36: pp. 2033-41 CrossRef
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• 刊物主题：Pediatrics; Rheumatology;
• 出版者：BioMed Central
• ISSN：1546-0096

文摘

Context Imaging of dactylitis in adult psoriatic arthritis suggests a pathophysiological role for enthesitis. However, histological definition of the dactylitic digit is unavailable. Objective 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. Design 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. Results 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 cellular inflammation. Fibrinous synovitis and mild reactive synoviocyte hyperplasia were seen. Conclusions Dactylitis in psJIA bears a radiographic resemblance to the condition in adult psoriatic arthritis. Histologic hallmarks include an expanded mast cell-populated extracellular myxoid matrix, cartilage degeneration, and a T cell-rich perivascular inflammatory infiltrate. These findings help to define enthesitis as a clinicopathologic entity.