title: Enthesitis in psoriatic arthritis.
abstract: OBJECTIVE
  It is increasingly recognized that enthesitis in patients with psoriatic arthritis (PsA) is of clinical importance. We review data on the detection, assessment, and treatment of enthesitis and its related dactylitis in PsA.
  
  
  METHODS
  We searched Pubmed with the search terms psoriatic arthritis or psoriasis in combination with enthesitis, enthesopathy, and treatment, or enthesitis in combination with imaging.
  
  
  RESULTS
  One hundred fifty-seven papers were selected. Enthesitis occurs frequently in PsA and may be asymptomatic or painful. It can also affect patient's function and quality of life. New imaging modalities, such as ultrasonography and magnetic resonance imaging, have revealed that enthesitis may be the initial osteoarticular inflammatory site in patients with PsA. Enthesitis indices have been developed and should be incorporated in clinical trials. Dactylitis, a characteristic and frequent manifestation of PsA can be tender or not tender and is prognostic of disease progression. Treatment of enthesitis includes non-steroidal anti-inflammatory drugs, classical DMARDs, and adjunctive local steroid injections. In inadequate response, TNFα inhibitors are used.
  
  
  CONCLUSIONS
  Enthesitis and dactylitis are important manifestations of PsA, and their evaluation is increasingly used in drug trials and clinical practice.
authors.affiliation: Department of Rheumatology, School of Health Sciences, University of Thessaly, Larissa, Greece; Center for Molecular Medicine, Old Dominion University, Norfolk, VA. Electronic address: lsakkas@med.uth.gr.
authors.forename: Lazaros I
authors.initials: LI
authors.lastname: Sakkas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Alexiou
authors.forename: Theodora
authors.initials: T
authors.lastname: Simopoulou
authors.forename: Marianna
authors.initials: M
authors.lastname: Vlychou
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000150:complications*; D018450:Disease Progression; D006801:Humans; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents
keywords: Assessment; Dactylitis; Enthesitis; Magnetic resonance imaging; Psoriasis; Psoriatic arthritis; TNFα inhibitors; Treatment; Ultrasonography