Dactylitis is severe inflammation of the finger or toe tendons and joints, making them look like sausages. You may experience pain in the affected joints and a reduced range of motion. The treatment depends on the underlying cause.
Dactylitis occurs due to inflammation known as tenosynovitis. This means that, unlike typical joint swelling that only affects the knuckle of a finger or toe, dactylitis causes inflammation of your entire finger or toe.
The puffy nature of the inflammation can make these digits look like sausages. Severe dactylitis can make your fingers so rigid that you can no longer make a fist.
The primary symptoms of dactylitis are swollen, painful digits and difficulty moving the affected areas. The inflammation can also cause your joints to feel warm. Additional symptoms differ based on the underlying cause.
For example, dactylitis caused by psoriatic arthritis (PsA) doesn’t have symmetrical joint involvement. This means that your individual digits may swell differently. For example, your left hand may be inflamed, while your right hand is unaffected.
Rheumatoid arthritis (RA) causes symmetric patterns of swelling in your body, hands, and feet.
Several conditions can cause you to develop dactylitis.
Psoriatic arthritis (PsA)
PsA is the inflammatory joint disease most associated with dactylitis. PsA is an autoimmune disease that causes your immune system to attack healthy tissue. This can trigger painful, damaging inflammation in your joints and the tissues surrounding the tendons.
There are five types of PsA:
- asymmetric PsA
- symmetric PsA
- distal interphalangeal predominant PsA
- psoriatic spondylitis, which affects the spine
- PsA mutilans, which affects bone tissue
Up to 30% of people with the skin condition psoriasis develop PsA, according to a 2018 literature review. Between 16% and 49% of people with PsA experience dactylitis.
The swelling and deformity in PsA can remain once the inflammation is gone.
Rheumatoid arthritis (RA)
RA is an autoimmune disease that causes your immune system to attack the joints. This results in tissue inflammation around the joints. Dactylitis isn’t a hallmark feature of RA, but the swelling from the inflammation can be sausage-like.
RA usually affects the following:
The swelling in RA can subside with treatment.
Infection in a part of your body can trigger reactive arthritis. It’s often the result of infections in your:
- urinary tract
Symptoms usually develop 1 to 3 weeks after exposure to the cause of the infection.
The bacteria that are often responsible for causing reactive arthritis are:
Reactive arthritis isn’t contagious, but many of the bacteria that cause this type of arthritis can be found in food or transmitted through sexual contact.
This type of arthritis can also cause:
- eye inflammation
- rash on your palms or soles
- urinary problems
In the early stages of reactive arthritis, symptoms may be mild and may go unnoticed. They can occasionally appear over several weeks or months. Urinary symptoms may appear first, while arthritis is usually the last symptom.
Sickle cell disease (SCD)
Dactylitis is one of the earliest symptoms of sickle cell disease (SCD), a blood disorder causing the red blood cells that carry oxygen through the body to become sticky and hard. Instead of flattened discs, the cells form a crescent shape resembling a farm tool called a sickle.
SCD often causes a shortage of red blood cells. Sickle cells may clog narrow blood vessels, which results in issues such as pain and infection.
The symptoms of SCD usually start appearing in the first year of life,
Dactylitis is very common in children with SCD.
Other early SCD symptoms include:
The following are some of the other conditions that, in rare cases, may cause dactylitis to develop:
- Tuberculosis: This infectious bacterial disease that can cause inflammation of the lungs may also cause inflammation of bones in the hands and feet, especially in children and adolescents.
- Syphilis: If untreated, this sexually transmitted infection can be transmitted to the fetus during pregnancy. Babies born with congenital syphilis may develop syphilitic dactylitis in their fingers and toes.
- Sarcoidosis: Sarcoidosis is an autoimmune condition that causes inflammation of the heart, lungs, and other organs. It affects adults between 20 and 40 years old. Sarcoid dactylitis may develop in the small bones of the hands and feet.
- Gout: Gout is a type of arthritis. This condition, which is most often caused by a buildup of uric acid, can lead to pain and swelling in foot joints. About 5% to 9.6% of people with gout may develop dactylitis.
- Lyme disease: Lyme disease is occasionally associated with dactylitis. After infection, the organism that causes Lyme disease can trigger reactive arthritis.
Dactylitis has many underlying causes. A doctor may order many different tests before making a diagnosis.
When you visit a doctor, make sure you have a list of:
- your symptoms
- key medical and personal information
You may also want to check whether anyone in your family has had similar issues. This information can help your doctor make a proper diagnosis.
PsA can often go undetected. Inflammation caused by PsA can be misdiagnosed as another type of arthritis such as RA, osteoarthritis, or gout.
Inflammation caused by arthritis can cause serious damage to your body. Improperly treated arthritis can lead to permanent joint deformity and loss of function.
Testing may include:
- looking for swollen joints, fingernail irregularities, and tender feet
- imaging tests, such as X-rays, MRI, or a musculoskeletal ultrasound (MSK), which provides pictures of your joints, ligaments, and tendons
- laboratory tests such as a joint fluid test to rule out gout or a blood test to rule out RA
In 2020, researchers created a new ultrasound scoring system called Dactylitis Global Sonographic to help determine the severity of dactylitis in the hands of people with PsA and to better assess the response to treatment.
With this system, which is primarily used in clinical trials, people are given a score from 0 to 25 for each hand. The score is calculated by adding the scores for each lesion of every affected finger, based on the results of an MSK.
For people with PsA, dactylitis is a marker of the disease’s severity. Finger and toe joints with dactylitis may have significantly more damage than joints without it.
Dactylitis may indicate other health risks as well.
The risk of a future cardiovascular event such as a heart attack or stroke increases by 20% for each finger or toe with dactylitis, according to a 2016 study of adults with PsA.
Treatment for dactylitis is based on the underlying condition that’s causing it.
Treatment for PsA
There’s no cure for PsA, but there are treatments that can help you manage your symptoms. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs).
NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), can help ease pain and decrease inflammation.
DMARDs and genetically engineered proteins called biologics can help relieve pain, lower inflammation, and prevent joint damage. Examples
- DMARDS such as methotrexate (Trexall), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), or leflunomide (Arava)
- the tumor necrosis factor inhibitors adalimumab (Humira) and infliximab (Remicade)
If flare-ups still occur despite treatment, corticosteroid injections into the protective sheaths of tendons may help provide months of relief, according to a 2021 study. Corticosteroids may also be simultaneously injected into your joints.
Examples include methylprednisolone (Medrol, Depo-Medrol), another off-label treatment.
Treatment for RA
- DMARDs, such as methotrexate (Trexall, Otrexup, Rasuvo) or azathioprine (Azasan, Imuran)
- biologics, such as etanercept (Enbrel) or infliximab (Remicade)
- biologic DMARDs, such as rituximab (Rituxan)
- janus kinase inhibitors (JAK inhibitors), such as baricitinib (Olumiant), tofacitinib (Xeljanz, Xeljanz XR), or upadacitinib (Rinvoq)
In severe cases where the loss of joint function is a concern, your doctor may suggest that you consider joint replacement surgery.
Learn more about RA treatments.
Treatment for reactive arthritis
If your reactive arthritis was caused by a bacterial infection, your doctor
- minocycline (Minocin, Dynacin)
- doxycycline (Monodox, Vibramycin)
They may also recommend NSAIDs, corticosteroids, or DMARDs used to treat chronic inflammation.
Physical therapy and exercise can also improve joint function and lower stiffness.
Learn more about treatments for reactive arthritis.
Treatment for SCD
Medications that the FDA has approved specifically for the treatment of SCD
- voxelotor (Oxbryta), an oral medication
- crizanlizumab-tmca (Adakveo), an intravenous infusion drug
- L-glutamine (Endari), an oral powder
Other possible treatments include:
- blood transfusions
- hydroxyurea (Hydrea, Droxia) to help prevent red blood cells from forming the sickle shape
- penicillin to lower the chance of infection in children
A blood and bone marrow transplant can cure SCD in some people.
Dactylitis can make it difficult to do your day-to-day activities. Some strategies for managing your condition are included below.
Working with a therapist
An occupational therapist or a physical therapist can work with you to retain some function of the small joints of your hands. They can also help you cope with the physical limitations that may interfere with your daily life.
It’s important to eat an anti-inflammatory diet to help manage inflammation.
An anti-inflammatory diet should include foods that are rich in antioxidants that lower the level of free radicals. Free radicals are molecules that can lead to inflammation.
For example, there’s some
- vegetables such as tomatoes, broccoli, and kale
- fruits such as apples, bananas, and oranges
- whole grains, including whole oats, brown rice, and whole wheat
- fish and other seafood, such as salmon, trout, and shrimp
- nuts and seeds, such as almonds, walnuts, and sunflower seeds
You should avoid inflammatory foods and beverages such as:
- items with added sugar, like candy and soft drinks
- refined grains like white bread
- trans fats, like those found in margarine and processed foods
- processed meats
According to research, extra weight is associated with more severe PsA symptoms and reduced benefits from medication.
Fatty tissue releases proteins such as adipokines and cytokines that can increase inflammation.
Losing even a modest amount of excess weight can help:
- lessen the severity of symptoms
- ease pressure on your joints
- increase the effectiveness of medications
Check out this writer’s perspective on managing her weight with PsA.
Adopting an exercise routine
Exercising your joints can lower stiffness and pain by increasing your range of motion and your strength. Consider the following low impact workouts:
Managing your anxiety
Anxiety and stress
Exploring home remedies
To help relieve the pain and inflammation associated with dactylitis, you can try the following home remedies:
- Apply a cold compress to your fingers or toes to help lower swelling.
- Apply a washcloth moistened with warm water to help loosen sore joints.
- Take a short, warm bath with Epsom salt.
- Add the spice turmeric to food or take it as a supplement. Turmeric contains curcumin, which lowers inflammation in people with psoriasis, according to a
2018 literature review. It may help treat PsA as well.
- Capsaicin cream, which is made with the substance that makes chili peppers hot, may help relieve painful joints.
- Fish oil is high in anti-inflammatory omega-3 fatty acids, a type of polyunsaturated fat (PUFA). According to a
2018 study, people with PsA who took 3 grams of a marine n-3 PUFA supplement daily used fewer NSAIDs than those who consumed a 3-gram capsule of olive oil.
Making lifestyle changes
Along with exercising and eating a nutrient-rich diet, the following lifestyle changes may help you manage the pain and inflammation from dactylitis:
- Wear compression socks or stockings to help lessen pain and swelling in your toes, or compression gloves to do the same for your fingers.
- Take steps to get a good night’s sleep. People with PsA are more likely to have sleeping issues, according to a 2018 study.
- Avoid smoking. In a
2019 study, researchers found that people with PsA who smoke didn’t respond as well to treatment as those who didn’t smoke.
Dactylitis can cause considerable pain and can affect your daily routine. However, there are many arthritis treatments available to help you manage the uncomfortable and painful swelling.
There’s no cure for most forms of arthritis, but with proper treatment, symptoms may become more manageable.
Leave a Reply