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.

• Mediastinal Lymphadenopathy

  Imaging studies revealed a "collar-stud" abscess in the left side of the neck, massive mediastinal lymphadenopathy with a left anterior chest wall abscess, and right thumb dactylitis that was typical of tuberculosis (TB). [ncbi.nlm.nih.gov]

• Parotid Swelling

  Herein, we present a three-year-old girl, who was previously vaccinated against mumps infection, admitted with bilateral parotid swelling, dactylitis and serum immunoglobulin M positivity for mumps infection and diagnosed to have ALL with bilateral persistent [medical-dictionary.thefreedictionary.com]

• Small Hand

  Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging, Skeletal Radiol, 1995, vol. 24 (pg. 351 - 5 ) 30,. [academic.oup.com]

• Subcutaneous Nodule

  Biopsy of a finger and of subcutaneous nodules showed similar features with a granulomatous infiltrate. There were no osseus or tendinous lesions. [ncbi.nlm.nih.gov]

• Neck 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]

• Excitement

  Herein, we discuss new exciting findings in animal models with enthesitis and dactylitis, summarize developments in clinical and imaging assessments and review recent clinical trial data on the efficacy of targeted therapies for enthesitis and dactylitis [ncbi.nlm.nih.gov]

  While individually each category is fun to think about, the excitement more than doubles when they occur concurrently (perhaps I am being facetious). Let’s review Blistering Distal Dactylics ! [pedemmorsels.com]

• Nephrolithiasis

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

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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