Most types of arthritis cause swelling, but the swelling of dactylitis is something else all together. “My fingers feel like they are going to burst,” psoriatic arthritis (PsA) patient Emily Terbrock told us on Facebook. This incredibly painful, red, and hot swelling can cause fingers to look like sausages, giving dactylitis the nickname “sausage fingers.”
Dactylitis, though, can be distinguished from regular joint swelling. “Dactylitis is the swelling of an entire digit — finger or toe — rather than just a knuckle within the finger or toe,” says rheumatologist Arthur M. Mandelin II, MD, PhD, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “Usually, the affected digit is most swollen in the middle and less swollen at the ends, taking on a cigar-shaped appearance.”
Dactylitis is associated with spondyloarthritis, which is an umbrella category of arthritis that notably causes symptoms in the spine, as well as other joints.
“Dactylitis can be associated with all of the spondyloarthropathies, including IBD-related inflammatory polyarthritis and reactive arthritis, but it’s most commonly with psoriatic arthritis,” says Mona Indrees, MD, a rheumatologist at AnMed Health in South Carolina. “Dactylitis can also be seen in other conditions such as sickle cell disease, gout, sarcoidosis, TB, and syphilis.”
These conditions can be differentiated by other clinical features and laboratory tests, says rheumatologist and researcher Dafna Gladman, MD, professor of medicine at the University of Toronto.
Because of the close connection between dactylitis and psoriatic arthritis, its presence can be used to diagnose psoriatic arthritis and distinguish it from other forms of arthritis.
“I have PsA and my first symptom was pain in my finger, which was misdiagnosed as tendinitis for months. It got to the point where my finger couldn’t bend at all, swelled twice its size, and was extremely hot,” Erin Jean Wheller told us on Facebook. “My rheumatologist took one look at me and immediately knew it was [psoriatic] arthritis.”
Other patients also told us dactylitis was one of their first PsA symptoms as well; its presence can be helpful in leading to a quick and accurate diagnosis.
“Dactylitis is caused by uncontrolled inflammation that results from spondyloarthropathies, and can be associated with flaring of the underlying joint disease,” Dr. Idrees says. “The swelling is diffuse and continuous throughout the tissue, affecting tendons, ligaments, synovium — the space that contains the joints and joint capsule — and adjacent soft tissue.” (Here’s more information about synovitis.)
In terms of why there’s such a strong association between dactylitis and psoriatic arthritis, there’s still no definitive answer, but Dr. Mandelin has some ideas. “It isn’t clear why dactylitis happens, but it is likely that its origin is related to the fact that patients with psoriatic arthritis have a tendency to develop inflammation of tendons and the surrounding tendon sheaths in addition to inflammation of the actual joints,” he says.
Dr. Idrees says the condition is often painful and can also severely limit functionality. The patients we heard from bore this out, describing incredible pain from their hands touching anything at all; a heavy, hot feeling; and not being able to bend or use their fingers.
“When it happens it starts out as a tightness, and eventually gets to the point where the skin is stretched so tight that it becomes itchy,” Lyin Despres described on Facebook. “Each movement of the affected finger is excruciating. It feels as though the nerves are being compressed by the swelling and if you move you will be tortured. You can’t get dressed or undressed, eat, use the bathroom, or do much of anything unassisted when this happens to both hands at the same time.”
Unfortunately, the presence of dactylitis often denotes more severe disease, Dr. Gladman says. “Digits with dactylitis are more likely to have damage than those without dactylitis,” she says. Dr. Mandelin says it’s important to note, though, that this is just an increased risk, and not a guaranteed outcome. “The take-away message is that patients with dactylitis should probably be watched more closely and have their disease controlled more tightly in order to try to counteract this risk,” he says.
Many patients we heard from said once they were diagnosed and found the right medicines for them, their dactylitis subsided. “I have had dactylitis in my fingers and a toe,” Joan Wzontek Alba told us on Facebook. “Now I’m on biologics and haven’t had a sausage finger since I found one that works.”
All three doctors we talked with agreed that biologics are more effective in treating dactylitis than conventional disease-modifying antirheumatic drugs (DMARDs).
“Even if joint disease responds to traditional DMARDS, dactylitis can be resistant, and at that point we may add a biologic,” Dr. Idrees says. “Research so far shows the most effective control of dactylitis comes from the use of biologics, including TNF inhibitors and some of the newer agents like ustekinumab and secukinumab, but one has to weigh the risks versus benefits.”
In addition to biologics, Dr. Mandelin advises patients with dactylitis to strongly consider “the new small-molecule JAK inhibitor agents, as these are clearly more effective against dactylitis than traditional DMARDs such as methotrexate.”
- Talk with your doctor to see which medication is right for your symptoms—and make sure you adhere to your medication regimen, Dr. Idrees says.
- If you have psoriatic arthritis, Dr. Mandelin advises to make sure you’re seeing a rheumatologist and a dermatologist, as the disease is complicated and needs to be addressed from all sides. “Psoriatic arthritis is more complex than many other forms of arthritis, and can affect the body in several unusual ways that aren’t always a concern with other forms of arthritis — dactylitis is only one such example,” he says.
- Let your doctor know right away if you experience dactylitis. “It is important to treat dactylitis immediately so that it does not become a chronic problem,” Dr. Gladman advises.
In addition to medical treatments, some patients we heard from had suggestions for treating dactylitis at home. Talk to your doctor before trying home remedies.
- Use cold packs or soak hands in cold water.
- Wear compression gloves, or finger sleeves like volleyball and basketball players use.
- Try warm paraffin wax, icy hot, or other warming treatments.
- Keep fingers moving with crochet or knitting, a stress ball, or even just flex and release.
- Do regular range-of-motion exercises for fingers and toes.
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