Medical News Today: What causes dactylitis (sausage fingers)?

Dactylitis is swelling of the fingers and toes that can cause them to have a sausage-like appearance. Sometimes called sausage digit, dactylitis can be a symptom of several different medical conditions.

In this article, we look at the most common causes of dactylitis, as well as how it is diagnosed and treated.





What is dactylitis?


Allergic reaction in hands, causing redness and swelling.
Dactylitis causes the fingers and hand to be become bloated and swollen.


One of the ways the body’s immune system responds to illnesses and injuries is through a process called inflammation. Inflammation causes swelling, pain, and other physical changes while the body is fighting an infection.


Dactylitis is a form of inflammation in the fingers or toes. Symptoms include swelling in one or more fingers or toes, and often in the entire hand or foot. The swelling gives the fingers a bloated, sausage-like appearance. The swelling may be painful and can make it difficult to move the affected area.


Dactylitis can be due to an infection or because of a change in the immune system. It is often the result of an autoimmune disorder. Autoimmune diseases cause the immune system to attack healthy tissues.




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Six common causes of dactylitis


Any disease or infection that causes inflammation has the potential to cause dactylitis. The most common causes of swollen fingers or toes include:


1. Sickle cell disease


Sickle cell disease is a group of genetic disorders of the red blood cells. Normally, red blood cells are shaped like discs. In people with sickle cell disease, changes in hemoglobin can alter the shape of blood cells to a sickle or curved shape.


Hemoglobin carries oxygen around the body, so changes in hemoglobin proteins can affect the body’s ability to get enough oxygen. The lack of oxygen in the tissues causes sudden, severe pain and a person may need to go to the hospital for treatment.


Dactylitis may be the first symptom in people with sickle cell disease, especially in children. It can appear in infants as young as 6 months old.


When dactylitis occurs as a side effect of sickle cell disease, it can be accompanied by a fever, pain, and an increase in white blood cells. Children with swollen fingers should be evaluated by a doctor for sickle cell and other diseases.



2. Tuberculosis


Dactylitis is a rare complication of tuberculosis. Tuberculosis is an infectious bacterial disease that can cause inflammation in the lungs. In rare cases, it can cause bone inflammation.


This bone inflammation causes the bones of the hands or feet to swell, producing pain and changes in the shape of the fingers or toes. In most cases, only one side of the body is affected. Leprosy is another disease that can cause similar changes in the fingers.



3. Sarcoidosis


Sarcoidosis is an inflammatory autoimmune disease 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.


4. Syphilis


Syphilitic dactylitis <br>Image credit: Internet Archive Book Images, (2015, September 17)</br>
Syphilitic dactylitis may be caused by congenital syphilis.
Image credit: Internet Archive Book Images, (2015, September 17)


Syphilis is a sexually transmitted infection (STI). Pregnant women with syphilis can pass the disease on to their babies, 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, and usually, affects both sides of the body.


5. Spondyloarthritis


Spondyloarthritis refers to types of arthritis that affect the joints and the entheses, which are the tissues where tendons and ligaments attach to bones. One of the most common forms of spondyloarthritis is psoriatic arthritis. Dactylitis can sometimes be a sign of advanced psoriatic arthritis.


Dactylitis is common in spondyloarthritis, affecting about a third of people with the condition. Researchers do not yet have a clear understanding of why so many people with spondyloarthritis get dactylitis, but they know it is due to swelling in the joints and surrounding tissues. 


People with rheumatoid arthritis do not get dactylitis, so some doctors use the presence of dactylitis to help diagnose the form of arthritis a person has.



6. 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.


A form of dactylitis called blistering distal dactylitis is due to an infection of the fatty pad of a single finger or toe. Commonly caused by skin infections, such as Streptococcus or Staphylococcus, this form of dactylitis occurs due to problems with circulation.


Blistering distal dactylitis can be extremely painful and may produce lesions or blisters on or near the affected area. The condition is more common in children than in adults.



Symptoms and diagnosis


Dactylitis <br>Image credit: Internet Archive Book Images, (2015, September 17)</br>
Dactylitis will be diagnosed with various tests, rather than just a visual assessment.
Image credit: Internet Archive Book Images, (2015, September 17)


The symptoms of dactylitis vary depending on the cause. For example, infections tend to affect only one finger, while dactylitis due to syphilis affects multiple fingers.


The appearance of dactylitis alone cannot accurately diagnose the cause. Instead, a doctor may perform X-rays or take blood tests to help determine the cause. They will also ask about the person’s medical history.


The doctor may ask when the swelling appeared, whether it is accompanied by other symptoms, and whether the person has been previously diagnosed with an autoimmune disorder, inflammatory condition, or infection.




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Treatment and management


Treatment for dactylitis primarily involves addressing the underlying cause of the swelling.


People with arthritis may need to take arthritis medications, while infections may require antibiotics. If the swelling is painful, a doctor may prescribe pain medications or recommend the use of non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen.


A person with tuberculosis or sickle cell disease may be very ill and require hospitalization. This is especially true for children.



Outlook


With prompt treatment, the outlook for dactylitis is good. The pain and swelling typically go away when the underlying condition is treated. In the case of sickle cell-related dactylitis, the swelling usually goes away on its own.


Many causes of dactylitis, however, are incurable chronic illnesses. These diseases 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 disease 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 sees a doctor as soon as possible for swollen fingers.

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