Dactylitis: Can PsA Cause Sausage Toes or Digits? | MyPsoriasisTeam

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Dactylitis: Can PsA Cause Sausage Toes or Digits?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Victoria Menard
Updated on January 2, 2024

Psoriatic arthritis (PsA), a type of inflammatory arthritis, often causes swollen fingers and toes — a symptom called dactylitis that’s commonly referred to as “sausage digits.” With PsA, the body’s immune system mistakenly attacks its own healthy tissues, resulting in painful swelling and other symptoms. Along with causing joint pain, swelling, and stiffness, psoriatic arthritis can lead to dactylitis.

If you’ve experienced this kind of inflammation, you’re not alone. Psoriatic arthritis affects up to one-third of people with psoriasis, and dactylitis affects nearly 40 percent of people with PsA.

Here’s what you need to know about dactylitis, including what causes it, what it feels like, and how you and your doctor or rheumatology team can help manage it.

What Is Dactylitis?

Dactylitis refers to inflammation that affects a digit (a finger or toe). The digit swells into the shape of a sausage, which is why dactylitis is also called sausage digits, sausage fingers, or sausage toes.

Dactylitis is considered one of the defining characteristics of psoriatic arthritis and is often used to help diagnose PsA. One MyPsoriasisTeam member even shared that their PsA was diagnosed from one finger affected by dactylitis.

What Does Dactylitis Look and Feel Like?

Fingers and toes affected by dactylitis become swollen or appear sausagelike. This swelling is localized — it affects only that particular digit. Dactylitis may also cause digits to become sore and tender, warm, and slightly discolored. Unlike PsA itself, which may affect just the small joints in the fingers and toes, dactylitis involves the entire digit.

Many MyPsoriasisTeam members have shared their experiences with dactylitis. As a member wrote, “My biggest PsA difficulty is dactylitis in my fingers and toes — especially fingers.”

Some people also experience pain. One member shared that they were “stiff, sore, and swollen” in their toes and fingers, while another wrote about pain in their back, knees, right wrist, and ”lovely sausage fingers.”

Dactylitis in the Fingers

Dactylitis affects almost 40 percent of people with psoriatic arthritis. The inflammation can make fingers swell or appear sausagelike, leading to stiffness and limited mobility. (CC BY-NC-ND 3.0 NZ/DermNet)

Dactylitis that affects the fingers often causes limited mobility or stiffness. One member shared that their fingers were so swollen they “could hardly bend them.” Another wrote, “I’ve ‘lost’ (still there, but in far different shape and function) two fingers and one or two toes to this dactylitis.”

The characteristic swelling of dactylitis can also make some tasks more difficult than usual. As one member described, “My two fingers (one on each hand) are so permanently swollen that I can’t make a complete fist.”

“Two of my fingers are so swollen — I can’t get my wedding rings off my finger,” another member shared. “On the other hand, I can’t get my ring off my index finger.”

Dactylitis in the Toes

Psoriatic arthritis tends to affect the feet more than the hands and can cause dactylitis in the toes. The swelling, pain, and stiffness may limit range of motion and make it hard to walk. (Medical Images)

Studies have found that PsA tends to involve the feet more often than the hands, particularly affecting the fourth toe. Imaging tests can help differentiate between dactylitis caused by psoriatic arthritis and other forms of arthritis that can affect the feet, such as rheumatoid arthritis or gout.

Like dactylitis in the fingers, inflammation in the toes can cause a swollen, sausagelike appearance as it spreads. Dactylitis can also lead to pain and stiffness in the toes, limiting range of motion or making walking difficult.

What Causes Dactylitis in Psoriatic Arthritis?

Generally speaking, dactylitis results from systemic (widespread) inflammatory conditions, including psoriatic arthritis. In people with PsA, the body’s immune response overreacts, leading to inflammation and the resulting symptoms of psoriatic arthritis.

Health experts believe that dactylitis primarily results from inflammation with soft tissue involvement. This inflammation, known as flexor tenosynovitis, affects the membrane surrounding the tendons in the fingers and toes (called the flexor tendon sheath). Inflammation in the fingers and toes leads to the appearance and symptoms of dactylitis.

Dactylitis and Enthesitis in Psoriatic Arthritis

Research has shown that dactylitis is also associated with erosive joint damage caused by enthesitis. Enthesitis refers to inflammation in the enthesis, one of the more than 100 sites in the body where ligaments or tendons (tough connective tissues) insert into the bones. Because of its high prevalence in people with PsA, enthesitis, like dactylitis, is considered a hallmark of psoriatic arthritis. Doctors often use the presence of enthesitis to confirm a diagnosis of PsA.

Enthesitis can develop in the flexor tendon pulleys — sites that help the fingers and toes move properly. Because these pulley sites are under frequent pressure as they rub against bone, they are prone to inflammation, which researchers have suggested causes the changes in physical function seen in enthesitis alongside dactylitis.

Managing Dactylitis in Psoriatic Arthritis

A doctor, such as a rheumatologist, can help you find the best ways to control your dactylitis. Dactylitis is managed by treating the underlying psoriatic arthritis. It’s important to address your PsA as early as possible, because dactylitis progresses along with the disease when left untreated.

Keep in mind that treatment may require some patience, and the first medication you try may not be the right one. As one MyPsoriasisTeam member wrote, “I’m about to try my sixth one.”

Your doctor may recommend or prescribe the following treatments to reduce PsA disease activity to help manage your dactylitis.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs), which help relieve pain and reduce inflammation, are used for the initial management of dactylitis. Your doctor may recommend over-the-counter medications, like ibuprofen (Advil) or naproxen (Aleve), for mild to moderate symptoms. If you have more severe discomfort, your doctor may prescribe stronger options.

Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs) reduce inflammation and slow PsA progression. DMARDs that are used to manage dactylitis include sulfasalazine, methotrexate (Otrexup, Rasuvo, Trexall), cyclosporine, and leflunomide (Arava). However, research suggests that DMARDs are only mildly effective in managing dactylitis.

Biologics

If conventional DMARDs aren’t successful in treating your PsA, your doctor may prescribe a certain type of DMARD known as a biologic. Biologics, including tumor necrosis factor (TNF) blockers, have been found to greatly improve dactylitis in many people. Anti-TNF drugs are used for resistant cases. Biologics your doctor may prescribe include the following:

Steroid Injections

Steroid injections, which are administered directly into the affected digits, quickly reduce inflammation and ease discomfort. Your doctor may prescribe a corticosteroid such as ustekinumab (Stelara) to manage symptoms.

Meet Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. Here, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with PsA.

Have you experienced dactylitis as a result of your PsA? How do you manage the pain? Share your story with others in the comments below or by posting on your Activities page.

Updated on January 2, 2024
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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