The size of the study population and the method for defining pulley thickness limited the study. Measurements were taken only in three digits of the dominant hand of each patient. Among PsA patients, only those with hand involvement participated in the study, which may limit the translation of the results to all PsA patients. Additionally, whether pulley changes trigger PsA tenosynovitis or whether it is a reactive process needs additional investigation.
The results of the study suggest that accessory pulleys are subjected to high physical stress and that they exhibit deep Koebner effects and thicken in response, Dr. Tinazzi and her associates wrote.
“Indeed, these findings suggest that such a mechanism is possible given the frequency of thickening of these structures in PsA” wrote Dr. Tinazzi and her associates. “It will be important to show that such changes are present in early PsA where their presence would support the idea of early biomechanical alterations in tendon function that could contribute to dactylitic tenosynovitis.”
This study received no external funding. Several of the researchers have received grants or honoraria from pharmaceutical companies.
SOURCE: Tinazzi I et al. Ann Rheum Dis. 2018 Mar 6. doi: 10.1136/annrheumdis-2017-212681.