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Dactylitis and PsA

Posted on February 15, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Victoria Menard

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects up to one-third of people with psoriasis. PsA is an autoimmune disease, meaning it occurs when the body’s immune system mistakenly attacks its own healthy tissues, causing pain and other symptoms. Along with joint pain, swelling, and stiffness, psoriatic arthritis can cause dactylitis — inflammation in the fingers or toes.

If you’ve experienced this kind of inflammation, you’re not alone. Dactylitis affects nearly 40 percent of people with psoriatic arthritis. Here’s what you need to know about dactylitis, including what causes it, what it feels like, and how you and your doctor can help manage it.

What Is Dactylitis?

Dactylitis refers to inflammation that affects a digit (finger or toe). The inflammation causes the digits to swell up into a sausage-like shape, which is why dactylitis is sometimes referred to as sausage digit or sausage fingers or toes.

Image courtesy of DermNet

Dactylitis is considered one of the defining characteristics of psoriatic arthritis. The presence of dactylitis is often used to help diagnose psoriatic arthritis. 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 sausage-like in appearance. This swelling is localized, meaning it only affects the involved digit. Dactylitis may also cause the digits to become sore and tender, warm, and slightly redder than the surrounding area.

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

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

In many cases, dactylitis causes difficulty moving the fingers and toes. 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 swelling characteristic of dactylitis can also make other 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.” Another member shared, “Two of my fingers are so swollen — I can’t get my wedding rings off my finger. On the other hand, I can’t get my ring off my index finger.”

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.

Modern imaging technologies, including ultrasound and magnetic resonance imaging (MRI), have allowed us to better understand the causes of dactylitis. Thanks to these methods, experts now 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 PsA

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 (muscles used to hold the bones together) insert into the bones. Thanks to its high prevalence in people with PsA, enthesitis, like dactylitis, is considered a “hallmark” of psoriatic arthritis. It is often used 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 becoming inflamed. The resulting inflammation has been suggested to cause 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, as dactylitis progresses along with the disease when left untreated.

Keep in mind that treatment may require some patience, as 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 Advil (Ibuprofen) or Aleve (Naproxen), 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) work by reducing inflammation and slowing down the progression of PsA. Some DMARDs used to manage dactylitis include Sulfasalazine, Trexall (Methotrexate), Cyclosporine, and Arava (Leflunomide). However, research suggests 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 Cosentyx (Secukinumab), Inflectra (Infliximab-dyyb), and Humira (Adalimumab).

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 Stelara (Ustekinumab) 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 87,000 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 MyPsoriasisTeam.

References

  1. Psoriatic Arthritis — Arthritis Foundation
  2. About Psoriatic Arthritis — National Psoriasis Foundation
  3. Related Conditions of Psoriasis — National Psoriasis Foundation
  4. Psoriatic Arthritis — Symptoms and Causes — Mayo Clinic
  5. Dactylitis — DermNet NZ
  6. Optimal Management of Dactylitis in Patients With Psoriatic Arthritis — Open Access Rheumatology
  7. Classification of Clinical Subsets en Psoriatic Arthritis — Rheumatology
  8. Dactylitis or “Sausage Finger/Toe” — Orthopaedic and Spine Center of Newport News
  9. Enthesitis and PsA — Arthritis Foundation
  10. Enthesitis: A Hallmark of Psoriatic Arthritis — Seminars in Arthritis and Rheumatism
  11. Dactylitis in Psoriatic Arthritis: A Marker for Disease Severity? — Annals of the Rheumatic Diseases
  12. Psoriatic Arthritis — Versus Arthritis
  13. Disease Modifying Anti-Rheumatic Drugs (DMARD) — StatPearls
  14. Psoriatic Arthritis — Diagnosis and Treatment — Mayo Clinic
  15. Dactylitis in Psoriatic Arthritis: Prevalence and Response to Therapy in the Biologic Era — Journal of Rheumatology
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 copywriter at MyHealthTeams. Learn more about her here.

A MyPsoriasisTeam Member said:

I deal with this daily, my fingers don't swell together so rheumatologist says I'm doing good. Just irritating the pain, not being able to use fingers, walking with a limp because i cannot bend my… read more

posted 4 months ago

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