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Dactylitis

Dactylitis refers to the inflammation of the finger or toe causing it to become swollen and painful.

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Presentation

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.

Workup

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].

Treatment

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.

Prognosis

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.

Etiology

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.

Epidemiology

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

Pathophysiology

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].

Prevention

There is no method for prevention.

Summary

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.

Patient Information

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.

References

  1. Olivieri I, Scarano E, Padula A, Giasi V, Priolo F. Dactylitis, a term for different digit diseases. Scandinavian Journal of Rheumatology. 2006;35(5):333-40.
  2. Ritz N, Connell TG, Tebruegge M, Johnstone BR, Curtis N. Tuberculous dactylitis--an easily missed diagnosis. European Journal of Clinical Microbiology and Infectious Diseases. 2011;30(11):1303-10.
  3. Helliwell PS, Firth J, Ibrahim GH, Melsom RD, Shah I, Turner DE. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. The Journal of Rheumatology. 2005;32(9):1745–1750.
  4. Olivieri I, Barozzi L, Favaro L, et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis and Rheumtism 1996;39(9):1524–8.
  5. Coates LC, Helliwell PS. Disease measurement--enthesitis, skin, nails, spine and dactylitis. Best PractIce and Resarch. Clinical Rheumatology. 2010;24(5):659-70.
  6. Haddad A, Johnson SR, Somaily M, et al. Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review. Journal of Rheumatology. 2015;42(8):1432-8.
  7. Maruschke L, Baumann T, Zajonc H, Herget G. Monostotic fibrous dysplasia of the middle phalanx of the hand. Journal of Medical Cases. 2013;4(5):318–322.
  8. Hassan FOA. Tuberculous dactylitis pseudotumor of an adult thumb: a case report. Strategies in Trauma and Limb Reconstruction. 2010;5(1):53–56.
  9. Fretzayas A, Moustaki M, Tsagris V, Brozou T, Nicolaidou P. MRSA blistering distal dactylitis and review of reported cases. Pediatric Dermatology. 2011;28(4):433-5.
  10. Bakewell CJ, Olivieri I, Aydin SZ, et al. OMERACT Ultrasound Task Force. Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. Journal of Rheumatology. 2013;40(12):1951-7.
  11. Gossec L, Smolen JS, Gaujoux-Viala C, et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Annals of Rheumatic Disease. 2012;71(1):4-12.
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