The main features are inflammation, pain, and swelling of the fingers, toes, hands, and/or feet. As a result, the digits are often referred to as "sausage fingers." Fever is also common. Furthermore, the overall clinical picture will reflect the underlying disease.

Dactylitis is a hallmark sign of psoriatic arthritis [5] as it is now included in the criteria for this disease [6]. Severe cases lead to disability.

Sickle-cell dactylitis affects young children and is self-limiting. Moreover, this type is associated with shortening of the digits which is also observed in tuberculosis dactylitis, syphilitic dactylitis and other pathologies [7] [8].

There is also another form referred to as blistering distal dactylitis. This describes a superficial infection of the anterior fat pad of the distal portion of a finger, which occurs predominantly in the pediatric population [9]. The organism responsible for this are group A beta-hemolytic streptococci.

• Pain

  Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale [arthritis-research.biomedcentral.com]

  Methods: Baseline dataset from the EsPeranza cohort (<45 years, symptoms duration 3-24 months and with inflammatory back pain -IBP- or asymmetrical arthritis or spinal/joint pain plus ≥1 SpA features) was analysed. [acrabstracts.org]

  Dactylitis refers to the inflammation of the finger or toe causing it to become swollen and painful. The main features are inflammation, pain, and swelling of the fingers, toes, hands, and/or feet. [symptoma.com]

  The result is a sudden pain attack, called a pain crisis. The pain may feel sharp, stabbing, intense, or throbbing. Some people with sickle cell disease say it’s worse than childbirth or the pain after surgery. [webmd.com]

  If you are having an extremely high fever and unbearable pain, then you should immediately ask for help. You should see your doctor right away if the pain won’t go away despite taking pain reliever at home. [healthfixit.com]

• Swelling

  A five-year-old girl presented with a history of left neck swelling for one week and right thumb swelling for three weeks. [ncbi.nlm.nih.gov]

  Dactylitis dactylitis Inflammation of a digit–a finger or a toe dac·ty·li·tis ( dak'ti-lī'tis ) Inflammation of one or more fingers. dactylitis Inflammation of the fingers and toes causing spindle-like (fusiform) swelling. [medical-dictionary.thefreedictionary.com]

  Pain in the joints and fingers: Sausage fingers or Dactylitis is the swelling of the fingers of the hands and also toes. Due to swelling, there is severe pain in the fingers and toes. [trendydamsels.com]

  Symptoms include swelling in one or more fingers or toes, and often in the entire hand or foot. The swelling gives the fingers a bloated, sausage-like appearance. The swelling may be painful and can make it difficult to move the affected area. [medicalnewstoday.com]

• Inflammation

  Dactylitis dactylitis Inflammation of a digit–a finger or a toe dac·ty·li·tis ( dak'ti-lī'tis ) Inflammation of one or more fingers. dactylitis Inflammation of the fingers and toes causing spindle-like (fusiform) swelling. [medical-dictionary.thefreedictionary.com]

  Dactyledema is edema (swelling) of the fingers or toes; dactylomegaly is enlargement … Medical dictionary dactylitis — n. inflammation of fingers and toes … English contemporary dictionary dactylitis — n. inflammation of a finger or toe caused by bone [translate.academic.ru]

  McGonagle and coworkers argued that the pathogenesis of tissue inflammation and damage in PsA involves biomechanical stress, with resultant synovial inflammation accompanied by the release of inflammatory cytokines, which in turn leads to diffuse inflammation [mdedge.com]

  NSAIDs can relieve pain and decrease inflammation. Antirheumatics can relieve pain, reduce inflammation and prevent joint damage. [novamedicum.com]

• Anemia

  Dactylitis commonly occurs in patients with homozygous hemoglobin S disease (sickle cell anemia), sickle cell-hemoglobin C disease or sickle cell-beta-thalassemia. [ncbi.nlm.nih.gov]

  Referred to as sickle cell dactylitis, this inflammation is regularly one of the principal symptoms of sickle cell anemia. [byebyedoctor.com]

  Causes : The major cause for getting dactylitis is sickle cell anemia, sickle cell disease and psoriasis. [diseasespictures.com]

  Dactylitis has numerous etiologies, which include sickle-cell anemia and spondyloarthropathies such as psoriatic arthritis and Reiter's syndrome. [symptoma.com]

  Yellow skin and whites of the eyes (also called jaundice or icterus) Anemia and Other Symptoms With sickle cell disease, you don't have enough healthy red blood cells. This is a condition called anemia. [webmd.com]

• Reiter Syndrome

  A number of conditions have been found to be associated with the HLA-B27 locus including ankylosing spondylitis, psoriatic spondylitis, Reiter's syndrome, juvenile arthritis, and others. [ncbi.nlm.nih.gov]

  Dactylitis has numerous etiologies, which include sickle-cell anemia and spondyloarthropathies such as psoriatic arthritis and Reiter's syndrome. [symptoma.com]

  Keratoderma blennorrhagica in a patient with Reiter’s syndrome. FIGURE 5. Keratoderma blennorrhagica in a patient with Reiter’s syndrome. [aafp.org]

• Diarrhea

  It may be that in this patient the disorder was secondary to severe diarrhea and dehydration. [ncbi.nlm.nih.gov]

  […] presence of dactylitis Characteristic OR 95% CI Chronic back pain 0.44 0.12 to 1.07 Inflammatory back pain 0.44 0.18 to 1.06 Peripheral arthritis 4.83 2.00 to 11.7 Enthesitis 2.49 1.24 to 5.03 Psoriasis 3.62 1.63 to 8.04 Nail lesions 0.61 0.12 to 3.18 Diarrhea [acrabstracts.org]

  The most common adverse events were diarrhea, nausea and other gastrointestinal ailments. There were no cases of tuberculosis. [mdmag.com]

  The most common were diarrhea, nausea, and headache. There were no serious cardiac events, malignancies, or opportunistic infections with longer term exposure. [medpagetoday.com]

  There was no history of trauma, psoriasis, diarrhea, sexually transmitted diseases, conjunctivitis, iritis, uveitis, mucosal ulceration, Raynaud's phenomenon, sarcoidosis or gout. [ijdvl.com]

• Vomiting

  Its treatment involves hydration and pain management.5 Our patient was readmitted 15 days later due to a 2-day history of fever with concomitant vomiting and diarrhoea without pathological products. [analesdepediatria.org]

  […] away on its own) Confusion (even if it goes away on its own) Garbled speech or an inability to speak (even if it goes away on its own) Sudden change in vision Severe headache Loss of consciousness Fever higher than 101°F (38.33°C) Severe cough Repeated vomiting [wellspan.org]

  […] away on its own) Confusion (even if it goes away on its own) Garbled speech or an inability to speak (even if it goes away on its own) Sudden change in vision Severe headache Loss of consciousness Fever higher than 38.3°C (101°F) Severe cough Repeated vomiting [healthlinkbc.ca]

• Nausea

  The most common adverse events were diarrhea, nausea and other gastrointestinal ailments. There were no cases of tuberculosis. [mdmag.com]

  The most common were diarrhea, nausea, and headache. There were no serious cardiac events, malignancies, or opportunistic infections with longer term exposure. [medpagetoday.com]

• Arthritis

  The patients who had had reactive arthritis (arthritis of peripheral joints, dactylitis, enthesitis, sacroiliitis) for more than 12 months were classified as having the chronic form of disease [12, 17]. [medical-dictionary.thefreedictionary.com]

  Psoriatic arthritis. Semin Arthritis Rheum1973;3:55–78. ↵ Veale D, Rogers S, Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. [ard.bmj.com]

  Reactive arthritis The doctor may prescribe an antibiotic if the reactive arthritis was caused by a bacterial infection. They may also recommend NSAIDs, corticosteroids, or disease-modifying medications that are used to treat rheumatoid arthritis. [novamedicum.com]

• Enthesopathy

  Enthesopathy is an inflammation of a tendon or ligament insertion to the bone. IMPACT evaluated the efficacy of infliximab (IFX) in PsA and was the first study to demonstrate improvement in dactylitis and enthesopathy. [jaad.org]

  An unusual clinical syndrome of "sausage-like" toe, or dactylitis, associated with an oligoarthritis involving the lower extremities has been reported in adults, as has HLA-B27 associated spondyloarthritis and enthesopathy in children. [ncbi.nlm.nih.gov]

  PsA, however, is more likely to be asymmetric and to present with enthesopathy (inflammation of tendons at their insertion sites that can often cause confusion with fibromyalgia), dactylitis (inflammation of a digit), and iritis (inflammation in the iris [medical-dictionary.thefreedictionary.com]

  Rheumatic and Musculoskeletal Diseases : "Psoriasis and the risk of foot and ankle tendinopathy or enthesopathy in the absence of psoriatic arthritis: a population-based study.” [webmd.com]

  […] improvement vs placebo in dactylitis count (mean change of -1.8 vs -1.3, P = 0.0097) and MASES (enthesitis) score (mean change of -1.3 vs -0.9, P = 0.0194) at week 24 1† * Pooled patient data from PALACE 1-3; includes all randomized patients with preexisting enthesopathy [otezla.net]

• Back Pain

  These characteristics included family history of SpA, clinical manifestations (chronic back pain –CBP-, inflammatory back pain–IBP-, peripheral arthritis, enthesitis, uveitis, psoriasis, nail lesions, inflammatory bowel disease –IBD- and urethritis or [acrabstracts.org]

  RESULTS: Dactylitis was observed in 12% of individuals with spondyloarthropathy, 17% with sarcoidosis, and 5% with gout, but not in 96 patients with rheumatoid arthritis or in 2,434 patients with osteoarthritis, neck or back pain, or collagen vascular [ncbi.nlm.nih.gov]

  Dactylitis and inflammatory back pain also are common. [aafp.org]

  Back to Top Signs and Symptoms Patients with PsA present with pain, swelling, stiffness, and tenderness of the joints, limiting motion. [clevelandclinicmeded.com]

• Arthralgia

  Dactylitis psoriatica must be suspected in cases of arthralgias progressing along the phalanges of a finger associated with global soft tissue swelling. [ncbi.nlm.nih.gov]

  Although patients with severe cutaneous psoriasis in general also develop arthralgia, the severity of the skin lesions does not always correlate with the presence of joint lesions. [dovepress.com]

• Joint Swelling

  This incredibly painful, red, and hot swelling can cause fingers to look like sausages, giving dactylitis the nickname “sausage fingers.” Dactylitis, though, can be distinguished from regular joint swelling. [creakyjoints.org]

  Dactylitis isn’t a hallmark feature of RA, but the swelling from the inflammation can be sausage-like. RA usually affects the following: hands wrists feet ankles elbows knees temporomandibular joint The swelling in RA can subside with treatment. [healthline.com]

  Radiograph of right hand (dorsal view) demonstrating diffuse swelling around PIP joint of right fourth digit, indicated by arrow. B. Radiograph of left fifth toe (oblique view) and C. [ped-rheum.biomedcentral.com]

• Ulcer

  An 86-year-old woman presented with marked blistering of her left index fingertip and ulceration of the left middle fingertip, with a 2-year history of recurrent blistering and ulceration of her fingers bilaterally. [ncbi.nlm.nih.gov]

  Extra-articular manifestations included in the analysis were enthesitis, dactylitis, nail disease, uveitis, and inflammatory bowel disease (Crohn disease and ulcerative colitis). [rheumatologyadvisor.com]

  Ulcers Ulcers Ulcers Cardiac conditions Aortic regurgitation, conduction defects Aortic regurgitation, conduction defects Aortic regurgitation, conduction defects Aortic regurgitation Pulmonary features Upper lobe fibrosis None None None Gastrointestinal [aafp.org]

  In clinical trials, other serious infections observed in patients treated with REMICADE ® included pneumonia, cellulitis, abscess, and skin ulceration. [remicadehcp.com]

  Given the nature of the infection and the continuous references to ulcers and sinuses that were discharging it is likely these would have been drained regularly as part of the general sanatorium treatment, alongside rest and fresh air. [northumberlandarchives.com]

• Skin Disease

  A comprehensive review of skin disease therapy is also provided, along with the various treatment options for joint disease, including traditional disease modifying therapy and newer biologic agents. [books.google.ro]

  On DermNet NZ Cutaneous tuberculosis Sarcoidosis Psoriatic arthritis Spondyloarthropathy Syphilis Books about skin diseases See the DermNet NZ bookstore. [dermnetnz.org]

  Painless dactylitis is not so common and can be treated incorrectly by both dermatologists and rheumatologists as skin disease. Left to progress it can cause morbidity later on with joint damage causing restrictions to everyday life. [academic.oup.com]

• Hyperactivity

  The most salient features of the examination were a splenomegaly of 3cm in the absence of hepatomegaly and hyperactive bowel sounds. [analesdepediatria.org]

Since there are numerous etiologies for dactylitis, the patient should be evaluated for them. The assessment consists of the history, detailed physical exam, and testing for the underlying disease. Radiography is the initial diagnostic study of choice while computed tomography (CT) and magnetic resonance imaging (MRI) are useful modalities for the exclusion of differential diagnoses [10].

• Colitis

  Extra-articular manifestations included in the analysis were enthesitis, dactylitis, nail disease, uveitis, and inflammatory bowel disease (Crohn disease and ulcerative colitis). [rheumatologyadvisor.com]

  The majority of reported REMICADE ® cases have occurred in patients with Crohn's disease or ulcerative colitis and most were in adolescent and young adult males. [remicadehcp.com]

  Quintessence Int 2018; 49: 209–217 Büttner R, Meier J: Chronisch entzündliche Darmerkrankungen, Colitis ulcerosa, Morbus Crohn. In: Behr M, Fanghänel J, Hautmann M, Proff P, Reichert TE (Hrsg): Medizin für Zahnmediziner. Dt. [online-dzz.com]

  […] conduction defects Aortic regurgitation, conduction defects Aortic regurgitation, conduction defects Aortic regurgitation Pulmonary features Upper lobe fibrosis None None None Gastrointestinal conditions None Diarrhea None Crohn’s disease, ulcerative colitis [aafp.org]

• HLA-B27

  A number of conditions have been found to be associated with the HLA-B27 locus including ankylosing spondylitis, psoriatic spondylitis, Reiter's syndrome, juvenile arthritis, and others. [ncbi.nlm.nih.gov]

  HLA-B27 associated dactylitis in children, J Rheumatol, 1988, vol. 15 (pg. 976 - 7 ) 8, ,,. Juvenile onset isolated B27 associated dactylitis, Semin Arthritis Rheum, 2003, vol. 32 (pg. 341 - 2 ) 9, ,. [academic.oup.com]

  Most patients were negative for HLA B27 (59.1%), rheumatoid factor (77.3%) and anti-CCP (63.6%). An extra-articular manifestation was present in all patients, namely enthesitis (40.9%). [repositorio.ul.pt]

Therapy aims to treat the underlying disease. In cases of psoriatic arthritis , nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line treatment. According to the European League Against Rheumatism (EULAR), when NSAIDS and/or glucocorticoid injections are ineffective, then disease-modifying antirheumatic drugs (DMARDs) should be considered [11]. Examples include tumor necrosis factor (TNF)-alpha inhibitors such as infliximab and targeted biologic therapies. Various classes of drugs can be used in conjunction with each other as well.

Different types of dactylitis are treated accordingly. Specifically, infectious cases are treated with antibiotics while tuberculosis is treated with an antitubercular regimen.

Other

Physical and occupational therapy may benefit patients, especially if the disease is disabling.

The long-term outcome depends on the responsible disease, its severity, and management. In psoriatic arthritis, the presence of dactylitis is indicative of aggressive disease as it can cause progressive damage to the joints.

Dactylitis has numerous etiologies, which include sickle-cell anemia and spondyloarthropathies [1] such as psoriatic arthritis and Reiter's syndrome. It may also manifest in extra-pulmonary tuberculosis [2], congenital syphilis, gonococcal arthritis, leprosy, gout and sarcoidosis.

Dactylitis occurs in 16% to 48% of individuals with psoriatic arthritis [3] and is observed in other forms of spondyloarthropathies as well.

The pathophysiology depends on the existing condition. Common features are flexor tenosynovitis and edema of the soft tissue in the hands along with synovitis [4].

There is no method for prevention.

Dactylitis is an inflammatory disease that affects the digit(s). The clinical presentation will include painful and swollen fingers and/or toes as well as the symptomology of the underlying disease. It is diagnosed through assessment of the overall picture, physical exam, and the relevant tests.

Dactylitis is an inflammatory disease which causes pain and swelling of the finger(s) and toe(s), which look like sausage fingers. There are many causes such as sickle-cell anemia, psoriatic arthritis, and others. It is diagnosed by history, physical exam, blood tests and imaging. The treatment depends on the cause.

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