Sausage Fingers: Dactylitis in Rheumatoid Arthritis

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  • Swelling Symptom

    Swelling Symptom

    Different kinds of arthritis can cause a painful swelling of your fingers and toes. Because of the way it makes your digits look, this symptom is sometimes called “sausage fingers.” The medical name for it is “dactylitis.”

    Psoriatic arthritis (PsA) also sometimes causes sausage-like swelling of the fingers. So does a group of other diseases known as spondyloarthritis (SpA), which includes PsA.

    Rheumatoid arthritis (RA) rarely leads to this condition, but can mimic its symptoms.  Although dactylitis and RA symptoms may look similar, they’re not the same. Dactylitis typically occurs asymmetrically, in one finger or toe at a time. RA usually affects several joints at the same time, and appears in the same area on both sides of the body. (For example, the knuckles of both hands.)  

  • What Is Dactylitis?

    What Is Dactylitis?

    According to the Scandinavian Journal of Rheumatology, “any inflammatory process involving the fingers or toes” can be considered dactylitis. Depending on the type of condition you have, different tissues may be involved in different types of swelling.

    In SpA, “sausage-like” digits are common. In addition to PsA, these diseases include ankylosing spondylitis, enteropathic arthritis, reactive arthritis, juvenile SpA, and undifferentiated SpA. RA may sometimes have this sign as well. However, RA is a disease that is indicated primarily by swollen joints.

  • Similar Process

    Similar Process

    Sausage-like symptoms are a common feature in PsA and SpA, they may also occur in people with RA

    Sometimes it can be difficult to tell the difference between RA and PsA because the symptoms both involve joint pain, inflammation, and swelling.

    According to the American Society for Surgery of the Hand (ASSH), the similarity of symptoms is due to the fact that the changes to your joints follow a similar process in both of these conditions.

  • What’s the Difference?

    What’s the Difference?

    When it comes to sausage-like digits, there are some distinct differences between RA and PsA that can help you tell the conditions apart. According to ASSH, RA often occurs in both hands, while PsA frequently affects just one hand.

    The swelling patterns can also be different. RA usually involves swelling of the large finger joint, called the MPC joint, or wrist swelling. PsA patients more often have swelling at a joint called the DIP, which is at the end of their fingers. Middle finger joints (PIP) can also be affected in PsA.

  • Not Everyone Gets It

    Not Everyone Gets It

    While some people who have RA may experience symptoms of dactylitis, it isn’t a symptom that many RA patients will get. The Mayo Clinic doesn’t list this symptom as a key sign of RA, but it does for PsA.

    In the journal Seminars in Arthritis and Rheumatism, researchers looked for sausage-like digits in all patients at the Arthritis Center of Northeast Ohio over a 10-year period.

    They found that the 96 patients with RA who went to the clinic during that period did not show signs of dactylitis. Researchers concluded that when dactylitis was present, they could rule out RA as a diagnosis.

  • Diagnosis and Treatment

    Diagnosis and Treatment

    Current Rheumatology Reports (CRR) notes that it can be difficult for doctors to diagnose dactylitis accurately. This is true even for PsA, for which this symptom is a “hallmark feature.”

    Additionally, there have not been enough studies on treatment of dactylitis to determine what can help control the swelling.

    The Current Rheumatology Reports research states that infliximab is the one medication that has been shown to help with this symptom in clinical trials. However, the trials were specific to PsA sufferers and not RA patients.

  • Swelling Solutions

    Swelling Solutions

    When it comes to helping with the general joint pain and swelling caused by RA, which may include symptoms of sausage-like digits, there are some steps you can take.

    Try making some lifestyle changes that may make a difference, along with any medicines that your doctor has prescribed. For instance, regular exercise can help strengthen the muscles that surround your joints. Water aerobics and swimming are recommended as well. You might also try applying heat or cold to swollen areas to reduce pain and decrease inflammation.

  • Next Steps

    Next Steps

    No matter which type of arthritis you have, your joints may be swollen, red, warm, and stiff.

    While joint swelling in the fingers and toes is a common symptom of RA, the “sausage-like” symptoms and appearance may—or may not—be present.

    If you think you may have dactylitis, talk to your doctor. Your doctor can help confirm a diagnosis based on your swelling patterns and other symptoms you may be experiencing.