Dactylitis: ‘Sausage Fingers’
What is dactylitis or “sausage fingers?”
Dactylitis is severe inflammation of the finger and toe joints. The puffy nature of the inflammation can make your digits look like sausages.
Severe dactylitis can make your fingers so rigid that you can no longer make a fist.
What are the symptoms of dactylitis?
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 are different based on the underlying cause.
For example, dactylitis caused by psoriatic arthritis (PsA) does not have symmetrical joint involvement. This means that your individual digits may swell differently. For example, your left hand may be inflamed while your right is unaffected.
Rheumatoid arthritis (RA) causes symmetric patterns of swelling in the body and the hands and feet.
What conditions cause dactylitis?
Several conditions can cause you to develop dactylitis:
Psoriatic arthritis (PSA)
PsA is the inflammatory arthropathy most associated with dactylitis. PsA is an autoimmune disease that causes your immune system to attack healthy tissue. This can trigger painful, damaging inflammation to joint and tendon sheaths.
There are five types of PsA:
- asymmetric oligoarthritis
- symmetric polyarthritis
- distal arthritis
- arthritis mutilans
About 30 percent of people with the skin condition psoriasis develop PsA, according to the National Psoriasis Foundation. Almost half of all people with PsA experience dactylitis.
Rheumatoid arthritis (RA)
RA is an autoimmune disease that causes the immune system to attack the joints. This causes tissue inflammation around the joints. Dactylitis is not a hallmark feature of RA, but the swelling from inflammation can be sausage-like.
The swelling in RA can subside with treatment. But the swelling and deformity in PsA usually remains once the inflammation is gone. RA usually affects:
Infection in a part of your body causes reactive arthritis. It’s often caused by infections in the genitals, urinary tract, or intestines. Symptoms usually develop about one to three weeks after exposure to the cause of the infection.
Bacteria that are often responsible for causing reactive arthritis are:
Reactive arthritis is not contagious. But many of the bacteria that cause this type of arthritis can be found in food or spread through sexual contact.
This type of arthritis can also cause stiffness, eye inflammation, and urinary problems.
How is dactylitis diagnosed?
Dactylitis has many underlying causes. Your doctor may order different tests before making a diagnosis.
When you visit your doctor, make sure you have a list of your symptoms, medications, and 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.
Testing for arthritis may include:
- looking for swollen joints, fingernail abnormalities, and tender feet
- imaging tests, like X-rays or MRI
- laboratory tests like a joint fluid test to rule out gout, or a blood test to rule out RA.
PsA can often go undetected. Inflammation caused by PsA can be misdiagnosed as another type of arthritis like RA, osteoarthritis (OA), or gout.
Inflammation caused by arthritis can cause serious damage to the body. Improperly treated arthritis can lead to permanent join deformity and loss of function.
How is dactylitis treated?
Treatment for dactylitis is based on the underlying condition that’s causing it.
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 can ease pain and decrease inflammation. DMARDs can relieve pain, reduce inflammation, and prevent joint damage.
Sausage fingers caused by RA
Your doctor may recommend the following medications to help manage the symptoms of RA:
- DMARDs, or disease-modifying antirheumatic drugs
- biologics, or genetically-engineered proteins
- JAK inhibitors, or janus kinase inhibitors
In severe cases where the loss of function is a concern, your doctor may suggest that you consider joint replacement surgery.
Sausage fingers caused by reactive arthritis
Your doctor may prescribe an antibiotic if your reactive arthritis was caused by a bacterial infection. They may also recommend NSAIDs, corticosteroids, or disease-modifying drugs used to treat RA.
Physical therapy and exercise can also improve joint function and reduce stiffness.
Coping with dactylitis
Dactylitis can make it difficult to do your day-to-day activities. Some strategies for managing your condition include:
Working with a therapist
A physical therapist or an occupational therapist can work with you to retain some function of the small joints of the hands. They can also help you cope with the physical limitations that may interfere with your daily life.
Eating well and staying active
It’s important to stay physically active and eat an anti-inflammatory diet to manage inflammation.
Also, losing excess weight can help:
- lessen the severity of symptoms
- ease pressure on joints
- increase the effectiveness of medications
Adopting an exercise routine
Exercising your joints can reduce stiffness and pain by increasing your range of motion and your strength. Consider the following low-impact workouts:
- tai chi
Managing your anxiety
Anxiety and stress can make symptoms feel worse. Trying meditation or yoga may help you feel better.
What’s the outlook for dactylitis
Dactylitis can cause considerable pain and can impact your daily routine. There are many arthritis treatments available to help you manage uncomfortable and painful swelling.
There’s no cure for most forms of arthritis but with proper treatment, symptoms may become more manageable.