Dactylitis refers to swelling in the fingers and toes that can cause them to take on a sausage-like appearance.
Dactylitis can be a symptom of several different medical conditions, including some forms of arthritis, tuberculosis (TB), and syphilis.
This article looks at the most common causes of dactylitis, its diagnosis, and its treatments.
One of the ways the body’s immune system responds to illness and injury is through inflammation. Inflammation causes swelling, pain, and other physical changes while the body is fighting an infection.
Dactylitis is a type of inflammation in the fingers or toes. Symptoms include swelling in one or more digits, often affecting the entire hand or foot. The swelling can give the fingers a bloated, sausage-like appearance. This swelling may be painful and make it difficult to move the affected area.
Dactylitis can occur due to an infection or because of a change in the immune system. It is often the result of an autoimmune condition. Autoimmune conditions cause the immune system to attack healthy tissues.
Spondyloarthritis refers to types of arthritis that affect the joints and the tissues where tendons and ligaments attach to bones.
One of the most common forms of spondyloarthritis is psoriatic arthritis. Dactylitis occurs in 16–49% of people with psoriatic arthritis, according to one paper.
Similar forms of dactylitis may also occur in reactive arthritis. Reactive arthritis develops in response to infections in other parts of the body. Bacterial infections of the intestine, such as salmonella, and sexually transmitted infections (STIs), such as chlamydia, are the most common causes of reactive arthritis.
The same paper states that dactylitis affects around 5% to 9.6% of people with gout. In cases of gout, excess uric acid deposits in the joints, causing inflammation.
People with rheumatoid arthritis do not get dactylitis, so some doctors may use the presence of dactylitis to help diagnose the form of arthritis a person has.
Some diseases and infections that cause inflammation have the potential to cause dactylitis. The most common causes of swollen fingers or toes include the following.
Sickle cell disease
Sickle cell disease refers to a group of genetic disorders that affect the red blood cells. Normally, red blood cells are disk-shaped. In people with sickle cell disease, however, changes in hemoglobin can alter the shape of blood cells to a sickle-like or curved shape.
Changes in hemoglobin proteins can affect the body’s ability to get enough oxygen. A lack of oxygen in the tissues causes sudden, severe pain, and a person may need to go to the hospital for treatment.
Dactylitis is a characteristic symptom of sickle cell disease, especially in children. It typically appears in infants at around 6 months old but can occur up to the age of 4 years.
When dactylitis occurs as a side effect of sickle cell disease, it may accompany a fever, pain, and an increase in white blood cells. Doctors should evaluate children with swollen fingers for sickle cell disease and other conditions.
TB
Dactylitis is an uncommon complication of TB. TB is an infectious bacterial disease that can cause inflammation in the lungs.
In rare cases, it can also cause bone inflammation. This bone inflammation causes the bones of the hands or feet to swell, causes pain and changes in the shape of the fingers or toes. In most cases, this only affects one side of the body.
Dactylitis is most common in children and adolescents with TB, though adults may also experience this complication.
Sarcoidosis
Sarcoidosis is an inflammatory autoimmune condition that can affect the heart, liver, kidneys, lungs, and other organs. It causes severe problems in the organs and can even be fatal.
Very rarely, sarcoidosis can affect the bones and muscles of the hands, causing painful swelling. People with this symptom may also develop lupus pernio, which causes lesions and plaques on the face, ears, and fingers.
Infection
Some infections can cause swelling of the tissue deep below the skin or even in the bone. This swelling can cause symptoms of dactylitis.
Blistering distal dactylitis can be extremely painful and may produce lesions or blisters on or near the affected area.
Dactylitis may also occur due to syphilis, which is an STI. Syphilis can spread to infants during pregnancy, resulting in congenital syphilis.
In rare cases, babies born with congenital syphilis can develop dactylitis of the fingers or toes. This is due to inflammation in the bone and tissue. It usually affects both sides of the body.
Dactylitis causes swelling and can lead to physical pain. As with many forms of inflammation, the skin around the affected area may feel sensitive.
Dactylitis can, therefore, impair a person’s ability to carry out their day-to-day activities.
Treatment for dactylitis primarily involves addressing the underlying cause of the swelling. For example, people with arthritis may need to take arthritis medications, while infections may require treatment with antibiotics.
If the swelling is painful, a doctor may prescribe pain medications or recommend the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen.
A person with TB or sickle cell disease may require hospitalization for these conditions.
Home remedies typically include managing the underlying cause of dactylitis and avoiding activities that may impact the affected area.
A person who has dactylitis due to arthritis
Applying a cold compress to areas of inflammation may also help reduce arthritis-associated flares.
With prompt treatment, the outlook for dactylitis tends to be good. The pain and swelling typically go away following treatment of the underlying condition. In the case of sickle cell-related dactylitis, the swelling usually goes away on its own.
However, many causes of dactylitis are incurable chronic conditions. These conditions may require ongoing treatment and management. If treatment stops working, dactylitis can reoccur.
People with psoriatic arthritis may have multiple dactylitis flare-ups as the condition progresses. Careful management and monitoring can reduce the severity of dactylitis and may prevent it from returning.
Because many of the conditions that cause dactylitis are serious, it is vital that a person contacts a doctor as soon as possible for swollen fingers.
Dactylitis, or sausage fingers, is a form of inflammation that primarily affects the fingers and toes. A person may experience dactylitis in a single digit, in multiple digits, or even in their entire hand or foot. Swelling from the condition is often painful.
Dactylitis can result from various forms of arthritis, sickle cell disease, TB, sarcoidosis, and multiple bacterial infections.
Treatment for the condition will typically focus on treating its underlying causes.