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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.

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Pictures

Pictures of dactylitis

causes of sausage fingers

Symptoms

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.

Accompanying 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.

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Causes

What conditions cause dactylitis?

Several conditions can cause you to develop dactylitis:

Psoriatic arthritis (PSA)

PsA is 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
  • spondyloarthritis
  • arthritis mutilans

About 30 percent of people with the skin condition psoriasis develop PsA. 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:

  • hands
  • feet
  • wrists
  • elbows
  • knees
  • ankles

Reactive arthritis

Infection in a part of your body causes reactive arthritis. It is usually 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:

  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter

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.

Diagnosis

How is dactylitis diagnosed?

Dactylitis has many underlying causes. Your doctor may order different tests before making a diagnosis.

Make sure when you visit your doctor 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 may 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.

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Treatment

How is dactylitis treated?

Treatment for dactylitis is different based on the underlying condition that is causing it:

PsA

There is 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:

  • corticosteroids
  • DMARDs, or disease modifying antirheumatic drugs
  • biologics, or genetically-engineered proteins
  • JAK inhibitors, or janus kinase inhibitors

In severe cases where 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 RA drugs.

Physical therapy and exercise can also improve joint function and reduce stiffness.

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Coping

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 is 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:

  • swimming
  • walking
  • biking
  • yoga
  • tai chi

Managing your anxiety

Anxiety and stress can make symptoms feel worse. Trying meditation or yoga may help you feel better.

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Outlook

What is 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 is no cure for most forms of arthritis but with proper treatment, symptoms may become more manageable.

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