Overview

Dactylitis, often referred to as "sausage digits," is a medical condition characterized by uniform swelling of an entire finger or toe. This swelling occurs due to inflammation of the joints, tendons, and surrounding soft tissues. Dactylitis is commonly associated with inflammatory conditions, especially certain forms of arthritis. It can affect both fingers and toes and may occur in one or multiple digits at the same time. The condition causes discomfort, stiffness, and can lead to difficulty in using the affected digits effectively.

Causes

Dactylitis is not a disease on its own but a symptom of underlying health conditions, primarily inflammatory diseases. Common causes include:

• Psoriatic Arthritis: A type of arthritis that affects some people with psoriasis, often leading to dactylitis.
• Spondyloarthritis: A group of inflammatory diseases, including ankylosing spondylitis and reactive arthritis, which can present with dactylitis.
• Sickle Cell Disease: Episodes of painful swelling of hands and feet (hand-foot syndrome) commonly seen in children.
• Tuberculosis (TB) Dactylitis: A rare form of bone infection due to tuberculosis affecting small bones, particularly in children.
• Infectious Causes: Bacterial infections leading to septic arthritis or flexor tenosynovitis can cause localized dactylitis.
• Sarcoidosis: A condition that causes inflammatory granulomas, sometimes affecting the digits.

Symptoms

The main symptom of dactylitis is noticeable swelling of the affected digit, but additional symptoms may include:

• Swelling: Entire finger or toe becomes swollen and puffy, resembling a sausage-like appearance.
• Pain: Ranges from mild discomfort to severe pain, particularly with movement.
• Stiffness: Reduced flexibility in the affected digit, making bending or extending difficult.
• Warmth and Redness: The swollen area may feel warm to the touch and appear red or discolored.
• Functional Limitation: Difficulty in performing tasks that involve gripping, writing, or walking (if toes are involved).
• Associated Symptoms: Joint pain, fatigue, or skin changes (in conditions like psoriatic arthritis).

Diagnosis

Diagnosing dactylitis involves a thorough clinical evaluation along with investigations to determine the underlying cause:

• Medical History: Discussion of symptoms, duration, and any history of joint problems, skin disorders, or infections.
• Physical Examination: Inspection of the swollen digit(s), joint mobility assessment, and detection of tenderness or warmth.
• Blood Tests: Inflammatory markers (ESR, CRP), rheumatoid factor, anti-CCP antibodies, and HLA-B27 may be tested depending on suspected causes.
• Imaging Studies: X-rays can show joint damage or bone involvement, while MRI or ultrasound help detect soft tissue inflammation and early joint changes.
• Joint Fluid Analysis: If infection is suspected, fluid may be drawn from the joint to identify infectious organisms.

Treatment

Treatment of dactylitis focuses on managing inflammation, relieving pain, and treating the underlying disease:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Help reduce pain and swelling in mild to moderate cases.
• Steroids: Corticosteroids may be injected locally or given orally to quickly control severe inflammation.
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Medications like methotrexate are commonly used for conditions like psoriatic arthritis.
• Biologic Therapies: Anti-TNF or other biologic agents are effective in managing refractory dactylitis, especially in spondyloarthritis and psoriatic arthritis.
• Antibiotics: Prescribed if a bacterial infection is the cause of dactylitis.
• Supportive Care: Rest, cold packs, and gentle exercises guided by a physiotherapist can help improve function and reduce discomfort.
• Treatment of Underlying Disease: Managing the primary condition (like sickle cell disease or tuberculosis) is key to preventing recurrent episodes.

Prognosis

The prognosis of dactylitis depends on the underlying cause and how early treatment is initiated:

• Good Outcomes with Treatment: Many individuals experience significant improvement in pain and swelling with proper management.
• Chronic Conditions: In autoimmune disorders like psoriatic arthritis, dactylitis may recur and require long-term therapy.
• Infection-Related Dactylitis: With timely antibiotics, infection-related cases generally resolve completely.
• Sickle Cell Dactylitis: Episodes tend to lessen with age, and management focuses on supportive care and preventing sickle crises.
• Impact on Quality of Life: Effective treatment reduces functional limitations and improves daily living activities.

With early diagnosis and appropriate treatment, dactylitis is generally manageable, allowing most individuals to maintain an active lifestyle with minimal limitations.