Dactylitis, commonly known as sausage fingers disease, is a concerning medical condition marked by significant swelling in the fingers or toes. Due to inflammation, the affected digits balloon to resemble sausages, often resulting in discomfort and restricted movement. Early recognition is crucial, as dactylitis can cause several underlying conditions, including psoriatic arthritis, rheumatoid arthritis, and infection, highlighting the need for timely intervention and diagnosis.

An informed approach to managing dactylitis centres on identifying and addressing its causes, offering a tailored treatment plan that can often be a lifelong commitment to symptom control.

Common Conditions Associated with Dactylitis

Below are the common conditions associated with this ailment:

Arthritis-Related Causes:

Psoriatic Arthritis: Up to 29.5% of people with psoriatic arthritis experience dactylitis.
Reactive Arthritis: Formerly known as Reiter's syndrome, reactive arthritis can manifest as dactylitis.
Gout: This form of arthritis, caused by excess uric acid, occasionally leads to dactylitis.
Ankylosing Spondylitis: Another spondyloarthritis condition where dactylitis can be present.

Infectious Causes:

Tuberculosis (TB): A bacterial infection that can cause dactylitis.
Syphilis: A sexually transmitted infection known to cause dactylitis in its secondary stage.
Bacterial Infections: Including blistering distal dactylitis, usually affecting the pads of the fingers.

Autoimmune and Other Conditions:

Sarcoidosis and Lupus: Autoimmune conditions that can lead to dactylitis.
Sickle Cell Disease: Particularly in infants and young children, this blood disorder can manifest as dactylitis.

Diagnostic Procedures

Diagnosing dactylitis requires a careful and systematic approach to identify the underlying condition accurately. The following steps are typically involved in the diagnostic process:

Physical Examination: A healthcare provider will conduct a thorough physical examination, focusing on the swollen fingers or toes. The examination will include noting the number of affected digits and the presence of tenderness, as well as measuring their circumference compared to unaffected ones to gauge the severity of the inflammation.
Imaging Tests: For individuals with suspected psoriatic arthritis, advanced imaging tests such as ultrasound or MRI may be employed. These tests provide a detailed view of the affected areas, helping to assess the extent of inflammation and any potential joint damage.
Laboratory Tests: Blood tests can reveal markers of inflammation or infection that may contribute to the dactylitis. Sometimes, a biopsy may be necessary for a definitive diagnosis, especially if an infection is suspected.

Treatment Options

Treatment for dactylitis is multifaceted, targeting the inflammation and the underlying condition causing the swelling. Here's an overview of the therapeutic strategies:

Medications:

The first line of defence often includes Nonsteroidal anti-inflammatory drugs (NSAIDs), which alleviate pain and reduce inflammation.
Corticosteroid injections may be administered directly into the affected digits for more severe cases to relieve swelling.
If the condition persists, Disease-Modifying Antirheumatic Drugs (DMARDs) such as methotrexate or sulfasalazine might be prescribed to slow disease progression and prevent joint damage.
Biologics, like certolizumab pegol or ustekinumab, specifically target the immune system components that drive inflammation.
Apremilast, an oral medication, has shown effectiveness in improving symptoms of dactylitis.

Supportive Care:

Cold therapy can help reduce swelling and discomfort.
Engaging in low-impact exercises maintains joint flexibility and reduces stiffness.

Treatment for Specific Causes:

Infections: Antibiotics are prescribed for bacterial causes, emphasising completing the course.
Gout: NSAIDs or medications to manage uric acid levels are used.
Sarcoidosis: May require NSAIDs, corticosteroids, or immunosuppressants.
Sickle-cell disease: Treatment includes pain management, hydration, and rest.

It is essential to consult a healthcare provider to tailor the treatment plan to the individual's condition and needs.

Causes Behind Dactylitis

Understanding the aetiology behind dactylitis is pivotal to its management and treatment. While the condition is frequently associated with inflammatory diseases, there are cases where swollen digits arise without inflammatory arthritis. Several non-inflammatory factors can contribute to the development of dactylitis:

Dietary Factors: High-sodium foods can cause the body to retain water, leading to swelling in various body parts, including the fingers and toes. Reducing salt intake can often alleviate this symptom.
Weight and Lifestyle: Excess body weight can increase pressure on the circulatory system, contributing to fluid retention and swelling in the extremities. Adopting a healthier lifestyle with regular exercise and a balanced diet can mitigate these effects.
Medication Side Effects: Some medications, including certain blood pressure medications, steroids, and diabetes medications, are known to cause swelling as a side effect. It is essential for individuals experiencing dactylitis to review their medicines with healthcare providers to determine if they may be contributing to the condition.

Conclusion

Dactylitis, also known as sausage fingers, is a painful and inflammatory condition that causes swelling in fingers and toes. It can affect one digit, multiple digits, or entire hands or feet. The condition's complexity stems from various diseases like arthritis, sickle cell disease, TB, sarcoidosis, and bacterial infections. Effective management involves addressing the root causes through targeted treatment strategies and improving the quality of life for affected individuals.

Frequently Asked Questions

Q1. What underlying medical condition leads to the development of sausage fingers?
A1. Dactylitis, also recognised as "Sausage Finger" or "Sausage Toe," is a symptom primarily associated with inflammatory autoimmune diseases such as Psoriatic arthritis and Rheumatoid arthritis. It manifests as painful, localised swelling that makes the fingers or toes resemble sausages.

Q2. What are the common causes that lead to dactylitis?
A2. Dactylitis may be caused by various conditions, including different forms of arthritis, sickle cell disease, tuberculosis (TB), sarcoidosis, and several bacterial infections. Addressing dactylitis usually involves treating these underlying conditions.

Q3. What are the potential consequences of not treating dactylitis?
A3. If dactylitis is not treated correctly, it can damage the fingers. This condition is prevalent in specific types of inflammatory arthritis, such as psoriatic arthritis and ankylosing spondylitis, and is a crucial indicator of psoriatic arthritis. The presence and severity of dactylitis can also indicate the potential severity of a psoriatic arthritis case.

Q4. Which bacteria are known to cause dactylitis?
A4. Dactylitis is most commonly caused by the group A beta-haemolytic streptococcus. However, it can also be caused by Staphylococcus aureus.

Reference articles:

https://www.medicalnewstoday.com/articles/319855#summary
https://www.healthline.com/health/swollen-fingers#takeaway
https://www.healthline.com/health/rheumatoid-arthritis/dactylitis#causes