Dactylitis Disease

Dactylitis Disease

Dactylitis Disease

OVERVIEW

Dactylitis is the medical term for severe swelling that affects your fingers or toes (your digits). It’s sometimes called “sausage fingers” because of the round, puffed up shape it gives your digits.

Most types of inflammation only affect a specific area. Usually, swelling will be concentrated in one spot that’s injured or damaged — picture the welt that forms on your leg if you bang your shin on a coffee table. But if you’re experiencing dactylitis, your entire finger or toe (the whole digit) will be swollen along its whole length.

*Pain.

*A feeling of warmth or heat.

*Discoloration.

*Difficulty moving or bending your digit the way you usually can.

Visit a healthcare provider if you notice any symptoms of dactylitis. Swelling that affects your whole finger or toe might be a symptom of a condition you already have, but it can also be a sign of a serious infection or a new issue that needs treatment as soon as possible.

Symptoms

The primary symptoms of dactylitis are swollen, painful digits and difficulty moving the affected areas. The inflammation can also cause your joints to feel warm. Additional symptoms differ based on the underlying cause.

For example, dactylitis caused by psoriatic arthritis (PsA) doesn’t have symmetrical joint involvement. This means that your individual digits may swell differently. For example, your left hand may be inflamed, while your right hand is unaffected.

Rheumatoid arthritis (RA) causes symmetric patterns of swelling in your body, hands, and feet.

Diagnoses

Dactylitis has many underlying causes. A doctor may order many different tests before making a diagnosis.

When you visit a doctor, make sure you have a list of:

*your symptoms

*medications

*key medical and personal information

You may also want to check whether anyone in your family has had similar issues. This information can help your doctor make a proper diagnosis.

PsA can often go undetected. Inflammation caused by PsA can be misdiagnosed as another type of arthritis such as RA, osteoarthritis, or gout.

Inflammation caused by arthritis can cause serious damage to your body. Improperly treated arthritis can lead to permanent joint deformity and loss of function.

Testing may include:

looking for swollen joints, fingernail irregularities, and tender feet

imaging tests, such as X-rays, MRI, or a musculoskeletal ultrasound (MSK), which provides pictures of your joints, ligaments, and tendons

laboratory tests such as a joint fluid test to rule out gout or a blood test to rule out RA

In 2020, researchers created a new ultrasound scoring system called Dactylitis Global Sonographic to help determine the severity of dactylitis in the hands of people with PsA and to better assess the response to treatment.

With this system, which is primarily used in clinical trials, people are given a score from 0 to 25 for each hand. The score is calculated by adding the scores for each lesion of every affected finger, based on the results of an MSK.

Causes

Several conditions can cause you to develop dactylitis.

Psoriatic arthritis (PsA)

PsA is the inflammatory joint disease most associated with dactylitis. PsA is an autoimmune disease that causes your immune system to attack healthy tissue. This can trigger painful, damaging inflammation in your joints and the tissues surrounding the tendons.

There are five types of PsA:

*asymmetric PsA

*symmetric PsA

*distal interphalangeal predominant PsA

*psoriatic spondylitis, which affects the spine

*PsA mutilans, which affects bone tissue

Up to 30% of people with the skin condition psoriasis develop PsA, according to a 2018 literature review. Between 16% and 49% of people with PsA experience dactylitis.

The swelling and deformity in PsA can remain once the inflammation is gone.

Rheumatoid arthritis (RA)

RA is an autoimmune disease that causes your immune system to attack the joints. This results in tissue inflammation around the joints. 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.

Reactive arthritis

Infection in a part of your body can trigger reactive arthritis. It’s often the result of infections in your:

*genitals

*urinary tract

*intestines

Symptoms usually develop 1 to 3 weeks after exposure to the cause of the infection.

The bacteria that are often responsible for causing reactive arthritis are:

*Salmonella

*Shigella

*Yersinia

*Campylobacter

Reactive arthritis isn’t contagious, but many of the bacteria that cause this type of arthritis can be found in food or transmitted through sexual contact.

This type of arthritis can also cause:

*stiffness

*eye inflammation

*rash on your palms or soles

*urinary problems

In the early stages of reactive arthritis, symptoms may be mild and may go unnoticed. They can occasionally appear over several weeks or months. Urinary symptoms may appear first, while arthritis is usually the last symptom.

Sickle cell disease (SCD)

Dactylitis is one of the earliest symptoms of sickle cell disease (SCD), a blood disorder causing the red blood cells that carry oxygen through the body to become sticky and hard. Instead of flattened discs, the cells form a crescent shape resembling a farm tool called a sickle.

SCD often causes a shortage of red blood cells. Sickle cells may clog narrow blood vessels, which results in issues such as pain and infection.

The symptoms of SCD usually start appearing in the first year of life, at about 5 months of ageTrusted Source.

Dactylitis is very common in children with SCD.

Other early SCD symptoms include:

*yellowish skin color

*yellowish whites of the eyes

*fatigue

Other causes

The following are some of the other conditions that, in rare cases, may cause dactylitis to develop:

*Tuberculosis: This infectious bacterial disease that can cause inflammation of the lungs may also cause inflammation of bones in the hands and feet, especially in children and adolescents.

*Syphilis: If untreated, this sexually transmitted infection can be transmitted to the fetus during pregnancy. Babies born with congenital syphilis may develop syphilitic dactylitis in their fingers and toes.

*Sarcoidosis: Sarcoidosis is an autoimmune condition that causes inflammation of the heart, lungs, and other organs. It affects adults between 20 and 40 years old. Sarcoid dactylitis may develop in the small bones of the hands and feet.

*Gout: Gout is a type of arthritis. This condition, which is most often caused by a buildup of uric acid, can lead to pain and swelling in foot joints. About 5% to 9.6% of people with gout may develop dactylitis.

*Lyme disease: Lyme disease is occasionally associated with dactylitis. After infection, the organism that causes Lyme disease can trigger reactive arthritis.

Treatment

Treatment for dactylitis is based on the underlying condition that’s causing it.

Treatment for PsA

There’s no cure for PsA, but there are treatments that can help you manage your symptoms. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs).

NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), can help ease pain and decrease inflammation.

DMARDs and genetically engineered proteins called biologics can help relieve pain, lower inflammation, and prevent joint damage. Examples includeTrusted Source medications typically used to treat RA, such as:

DMARDS such as methotrexate (Trexall), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), or leflunomide (Arava)

the tumor necrosis factor inhibitors adalimumab (Humira) and infliximab (Remicade)

If flare-ups still occur despite treatment, corticosteroid injections into the protective sheaths of tendons may help provide months of relief, according to a 2021 study. Corticosteroids may also be simultaneously injected into your joints.

Examples include methylprednisolone (Medrol, Depo-Medrol), another off-label treatment.

Treatment for RA

*DMARDs, such as methotrexate (Trexall, Otrexup, Rasuvo) or azathioprine (Azasan, Imuran)

*biologics, such as etanercept (Enbrel) or infliximab (Remicade)

*biologic DMARDs, such as rituximab (Rituxan)

*janus kinase inhibitors (JAK inhibitors), such as baricitinib (Olumiant), tofacitinib (Xeljanz, Xeljanz XR), or upadacitinib (Rinvoq)

In severe cases where the loss of joint function is a concern, your doctor may suggest that you consider joint replacement surgery.

Learn more about RA treatments.

Treatment for reactive arthritis

If your reactive arthritis was caused by a bacterial infection, your doctor may prescribeTrusted Source an antibiotic such as:

*minocycline (Minocin, Dynacin)

*doxycycline (Monodox, Vibramycin)

*hydroxychloroquine

They may also recommend NSAIDs, corticosteroids, or DMARDs used to treat chronic inflammation.

Physical therapy and exercise can also improve joint function and lower stiffness.

Learn more about treatments for reactive arthritis.

Treatment for SCD

Medications that the FDA has approved specifically for the treatment of SCD include:Trusted Source

*voxelotor (Oxbryta), an oral medication

*crizanlizumab-tmca (Adakveo), an intravenous infusion drug

*L-glutamine (Endari), an oral powder

Other possible treatments include:

blood transfusions

*hydroxyurea (Hydrea, Droxia) to help prevent red blood cells from forming the sickle shape

*penicillin to lower the chance of infection in children

A blood and bone marrow transplant can cure SCD in some people.

TYPE OF DOCTOR AND DEPARTMENT : Orthopedic SPECIALIST CAN DIAGNOSE THIS DISEASE.