Objectives Skin and joint involvement in psoriasis (PsO) and psoriatic arthritis (PsA) are thought to relate to the so-called Koebner response. Given that dactylitis is non-randomly distributed in the digits, this study tested the hypothesis that the accessory pulleys linked to the flexor tendons were thickened in PsA and thus exhibited koebnerisation. Methods Ninety-six subjects (27 PsA, 27 rheumatoid arthritis (RA), 23 PsO and 19 healthy controls (HCs)) were enrolled. The A1, A2 and A4 pulley thickness was measured using a high-resolution probe (22 MHz). All patients were in remission or low disease activity with current dactylitis being excluded. Results Within 864 pulleys investigated, patients with PsA had thicker pulleys in every digit compared with both RA (P<0.001 and P=0.003) and HCs (P<0.001). RA and PsO groups had some pulleys in some digits thicker than HCs whereas some others were comparable. The second digit A1 pulley thickness was higher in patients with PsA with previous dactylitis (P=0.020). More pulleys were thickened in the PsA group (165/243, 68%) than RA (41/243, 17%; P<0.001) and HCs (13/171, 7.6%; P<0.001). Conclusions In established PsA, the accessory pulleys are thickened compared with RA, PsO or HCs and especially in subjects with a history of dactylitis. These findings implicate the involvement of pulleys in PsA-related tenosynovitis and dactylitis supporting the idea of deep koebnerisation in dactylitis and sites of high physical stress.

中文翻译：

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屈肌腱相关辅助滑轮的“深 Koebner”现象作为银屑病关节炎腱鞘炎和指炎的新因素

目的 银屑病 (PsO) 和银屑病关节炎 (PsA) 的皮肤和关节受累被认为与所谓的 Koebner 反应有关。鉴于指趾炎在手指中非随机分布，本研究检验了与屈肌腱相连的辅助滑轮在 PsA 中增厚并因此表现出 koebnerisation 的假设。方法 招募了 96 名受试者（27 名 PsA、27 名类风湿性关节炎 (RA)、23 名 PsO 和 19 名健康对照 (HC)）。使用高分辨率探头 (22 MHz) 测量 A1、A2 和 A4 滑轮厚度。所有患者均处于缓解期或低疾病活动度，排除当前的指炎。结果 在调查的 864 个滑轮中，与 RA（P<0.001 和 P=0.003）和 HC（P<0.001）相比，PsA 患者的每个手指都有更厚的滑轮。RA 和 PsO 组的一些滑轮在某些数字上比 HC 厚，而其他一些则具有可比性。PsA 患者的第二个数字 A1 滑轮厚度更高（P=0.020）。PsA 组 (165/243, 68%) 比 RA (41/243, 17%; P<0.001) 和 HCs (13/171, 7.6%; P<0.001) 的滑轮增厚更多。结论 在已建立的 PsA 中，与 RA、PsO 或 HC 相比，附属滑轮增厚，尤其是在有指趾炎病史的受试者中。这些发现表明滑轮参与了 PsA 相关的腱鞘炎和指趾炎，支持了在指趾炎和高身体压力部位进行深度 koebnerisation 的想法。PsA 组 (165/243, 68%) 比 RA (41/243, 17%; P<0.001) 和 HCs (13/171, 7.6%; P<0.001) 的滑轮增厚更多。结论 在已建立的 PsA 中，与 RA、PsO 或 HC 相比，附属滑轮增厚，尤其是在有指趾炎病史的受试者中。这些发现表明滑轮参与 PsA 相关的腱鞘炎和指趾炎，支持在指趾炎和高身体压力部位进行深度 koebnerisation 的想法。与 RA（41/243，17%；P<0.001）和 HC（13/171，7.6%；P<0.001）相比，PsA 组（165/243，68%）的滑轮增厚更多。结论 在已建立的 PsA 中，与 RA、PsO 或 HC 相比，附属滑轮增厚，尤其是在有指趾炎病史的受试者中。这些发现表明滑轮参与 PsA 相关的腱鞘炎和指趾炎，支持在指趾炎和高身体压力部位进行深度 koebnerisation 的想法。