Dactylitis is a painful swelling of the fingers and toes. The name comes from the Greek word “dactylos,” which means “finger.”
Dactylitis is one of the telltale symptoms of psoriatic arthritis (PsA). It’s earned the nickname “sausage digits” because of the swelling in the affected fingers and toes.
Up to half of those with PsA will get dactylitis. In some people, it’s the first symptom — and it may be the only symptom for many months or years. In some cases, dactylitis can help doctors diagnose PsA.
Dactylitis also affects some people with gout, tuberculosis, sarcoidosis, and syphilis. The swelling looks different in these other conditions.
Dactylitis can also be a sign of more severe PsA and more joint damage. If you notice swelling in your fingers or toes, make an appointment with the doctor who treats your PsA.
Doctors don’t know what exactly causes dactylitis but the clinical findings of swelling and inflammation of the tendon sheaths are supported by MRI imaging and ultrasound findings consistent with flexor tenosynovitis.
The swelling stems from uncontrolled inflammation throughout the affected finger or toe. It affects many structures inside fingers and toes, including the tendons, ligaments, and the tissue lining the joint spaces (synovium).
Genes may play a role in causing dactylitis. When researchers looked at the different genes linked to PsA, they found one in common among people with dactylitis. People with other genetic variations had milder PsA and didn’t have dactylitis.
It’s unclear why it affects people with PsA, but not other types of arthritis, like osteoarthritis and rheumatoid arthritis.
Dactylitis involves the small joints of the fingers and toes and the areas where tendons and ligaments insert into the bone become inflamed. This inflammation produces swelling all the way down the finger or toe.
The swollen fingers or toes can be tender or painful, and sometimes red and warm to the touch. In fingers, pain often runs along the flexor tendons — the cords of tissue that connect the muscles of the lower arm to the bones of the thumb and fingers.
The swelling in dactylitis is asymmetrical, meaning that it affects different fingers and toes on one side of the body than on the other. It affects the toes more often than the fingers.
Often, two or more fingers or toes are swollen at once. The
When your toes or fingers are swollen, they may be hard to bend. This lack of flexibility can make it harder for you to do everyday tasks. The swelling may increase, making your fingers or toes feel tight as if the skin were being stretched.
To figure out whether you have this condition, your doctor will measure the swelling in your fingers and toes. Your doctor will also squeeze the affected digits and ask how much it hurts.
An ultrasound or MRI scan can show whether the swelling is from dactylitis or another cause, like a thickening of the tendon or fluid buildup in the digit. These tests also show how well you’re responding to treatment.
Dactylitis is more than just a symptom of PsA. It’s also a marker of the disease’s severity. There tends to be more damage in joints with dactylitis than in joints without it.
If you’re already on a PsA treatment and you have dactylitis, it can mean that the medication you’re on isn’t controlling your disease very well.
Having dactylitis can also warn of heart problems ahead. A
Most people with PsA have been prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid injections have also been used to treat this condition.
The next targeted treatment that doctors try is a disease-modifying anti-rheumatic drug (DMARD). However, recent studies have shown that biologic drugs like TNF inhibitors may be more effective for managing dactylitis.
Biologic drugs include:
- adalimumab (Humira)
- etanercept (Enbrel)
- infliximab (Remicade)
- ustekinumab (Stelara)
Along with taking your medication, you can try home remedies:
- Hold a cold pack to the affected fingers or soak your hands in cold water to bring down swelling
- Do exercises to keep your fingers flexible. A physical therapist can teach you exercises that are effective for PsA and dactylitis.
- Ask your doctor whether you should try a rub-on pain reliever.
- Wear compression gloves, which support your fingers and help to control swelling, pain, and stiffness.
Dactylitis is a common sign of PsA, and it can sometimes lead doctors to the right diagnosis. This swelling in fingers and toes isn’t just a painful symptom of PsA. It also can warn of severe joint damage, future disability, and even heart problems ahead.
It’s important to tell your doctor who treats your PsA right away if you develop this symptom. They’ll probably need to monitor you more closely to keep your PsA under control.
Some treatments you already take to manage your PsA can help bring down the swelling in your fingers and toes. Sticking with your treatment plan will help to ensure that dactylitis doesn’t become a long-term problem.