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Dactylitis or “Sausage Finger/Toe”

Dr. Carlson in the operating room
Jeffrey R. Carlson, MD
Dactylitis is a symptom that is most often seen in patients who have inflammatory Psoriatic or Rheumatoid arthritis, which are auto-immune diseases.  It is also known as “Sausage Finger” or “Sausage Toe” because of the localized, painful swelling that causes digits to look like sausages.  The fingers or toes may also be warm and difficult to move due to the swelling.  In this article, I will discuss how Dactylitis is treated, based on the underlying disease that causes the symptom.

When a patient experiences extreme swelling in their finger(s), toe(s), hand(s) or feet, they usually head for medical care right away.  When the usual suspect causes are ruled out, such as an insect/spider bite, allergic reaction, or a sprain or broken bone, a physician may begin to suspect another, more serious culprit is at play.  The treating physician will order a battery of tests, diagnostic imaging, extensively question the patient and will likely find the root cause of Dactylitis. There are also clues, such as only one hand or finger being affected, vs. both hands and multiple fingers. Does the patient have psoriasis? Joint pain, fevers or fatigue?  The answers to these questions help the physician make a diagnosis.
Once the underlying cause is determined, treatment can be administered.  For most patients, inflammatory arthritis is the culprit.  There are other less common causes, such as Sickle Cell Anemia, Tuberculosis, Sarcoidosis, Reactive Arthritis (caused by a bacterial infection) or Syphilis, which I will not address.

Psoriatic Arthritis (PsA) is an inflammatory, auto-immune disease which severely affects joints, tendons and connective tissues and is seen in 30% of patients with psoriasis.  They may have severe psoriasis or barely any skin symptoms. Patients experience pain, fatigue, depression, dry skin and eyes and other body issues. Dactylitis is a common symptom of this disease, seen in about half of the people who have PsA.  With PsA, there is typically no symmetry in the disease, which means only one hand or finger on one side of the body may be affected with the swelling and stiffness, but not the other. PsA is treated with prescription anti-inflammatory medications, corticosteroids, DMARDS (Disease Modifying AntiRheumatic Drugs), or Biologic drugs, injectable medications that alter the patient’s immune system.  Although there is no cure for PsA, the Dactylitis will subside or completely resolve as the root condition is brought under better control.

Rheumatoid Arthritis (RA) is an inflammatory, auto-immune disease that causes major damage to joints, organs and body systems, because the body’s immune system attacks them.  Patients experience pain, low-grade fevers, fatigue, weight loss and depression. Dactylitis is a less common symptom of this disease.  With RA, there is symmetry in the disease, which means both sides of the body are affected equally with swelling and stiffness.  RA is treated with prescription DMARDS (Disease Modifying AntiRheumatic Drugs), JAK inhibitors, Biologic drugs (injectable medications that alter the patient’s immune system) or corticosteroids.  The Dactylitis will lessen or end totally as the root condition is effectively treated, although there is no cure for RA.

Dactylitis sufferers, from both PsA and RA, can benefit from treatment with a Physical Therapist.  The Physical Therapist can help the patient maintain function and movement of the small joints in the hand, fingers, feet and toes.  Patients can be taught new, less painful ways of working, and doing daily activities.  The Physical Therapist can also use thermal modalities to provide warming pain and swelling relief for the patient’s sore and swollen extremities.

Patients who suffer from Dactylitis caused by inflammatory Arthritis are also encouraged to eat an anti-inflammation diet, such as the Mediterranean Diet, which constricts sugar, gluten, and alcohol, and encourages eating organic produce, lean meats in moderation, seafood and olive oil.  Losing weight is also extremely helpful for those who suffer with Arthritis.
Exercise is also encouraged as a treatment for Dactylitis.  Yoga, Tai Chi, water aerobics, swimming, walking or biking are all great, low impact exercises that will help to keep joints mobile and will help to reduce pain.  The endorphins released by exercise also help with pain and depression.

Although incurable, as inflammatory arthritis is managed and controlled, the symptom of Dactylitis should lessen or cease entirely.  If it develops, it is usually a sign that a person needs medical attention right away.  The sooner the underlying root condition is diagnosed and treated, the sooner the symptom of Dactylitis will go away, hopefully for good.

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