Dactylitis causes painful swelling in the fingers or toes. In some cases, dactylitis may be the first sign of psoriatic arthritis. It may also be a sign of more severe disease.

Unlike the arthritis itself, which causes inflammation in the joints, dactylitis causes inflammation in the entire finger or toe. Doctors can carry out a thorough diagnosis to identify the condition and determine the best treatment, which is important to halt progression.

In this article, we take a deeper look at the connection between dactylitis and psoriatic arthritis.

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Dactylitis and psoriatic arthritis both involve inflammation, but they are separate conditions.

Dactylitis

Dactylitis involves inflammation in a digit, meaning a finger or toe. The affected digits become painfully swollen and lose some of their definition. Due to this effect, people commonly refer to the condition as “sausage fingers.”

This inflammation occurs in many tissues throughout the digit, making it painful and even impossible to use at times.

Learn more about dactylitis here.

Psoriatic arthritis

Psoriatic arthritis is a form of arthritis that affects about 30% of people who have psoriasis. It is an inflammatory condition that causes swelling and pain in the joints. It may follow a pattern of flaring up and subsiding.

Learn more about psoriatic arthritis here.

Although dactylitis can occur with several other conditions, people see it as a hallmark symptom of psoriatic arthritis.

According to research in the journal Open Access Rheumatology, an estimated 39% of people with psoriatic arthritis also develop dactylitis.

More than half of the participants with dactylitis had their first flare-up before their arthritis diagnosis. In some people, dactylitis is the only symptom of psoriatic arthritis for months to years.

Experts do not know why dactylitis tends to affect people with psoriatic arthritis rather than those with other forms of arthritis.

They also do not know exactly what causes dactylitis. However, the swelling stems from uncontrolled inflammation throughout the affected digit, including the:

  • ligaments
  • tendons
  • tendon sheaths
  • synovium

The condition may have a genetic component as well.

Dactylitis causes inflammation in the small joints of the affected digits and the tissues within them, which can lead to swelling anywhere in the finger or toe.

Dactylitis swelling is asymmetrical, affecting different areas on either side of the body. In people with psoriatic arthritis, it is more common for dactylitis to occur in the toes.

The affected digits may bulge and feel very stiff. The skin may feel as though it is pulled too tight over the digit. Some people describe a feeling of the digit being about to burst.

Movement of the joints in the digit may be painful or very difficult and may interrupt everyday activities. It may hurt to touch the digit or for the digit to come into contact with anything at all.

A physical examination can sometimes be enough to diagnose dactylitis, although doctors may use other tests to check for underlying conditions.

Early diagnosis of psoriatic arthritis is key, as joint damage can occur rapidly. A dermatologist may also play a significant role in diagnosing psoriatic arthritis, as skin lesions appear before joint pain in about 70% of cases.

Similarly, the early detection and diagnosis of dactylitis are important, as the condition can progress and erode the joints if a person does not receive treatment.

A doctor may physically measure the amount of swelling in the area or touch the affected digit and ask about pain levels. If they suspect dactylitis, they may use a sensitive imaging test, such as an ultrasound or MRI, to check the area for signs of inflammation and damage.

Dactylitis is a characteristic symptom of psoriatic arthritis, and it damages and erodes the affected joints. It is also a marker for disease severity, as significantly more damage occurs in the joints with dactylitis than in unaffected joints.

People with psoriatic arthritis who experience new flare-ups of dactylitis should see a doctor to evaluate their treatment. If flare-ups continue to occur, it may mean that the current treatment is no longer controlling the condition.

There may also be a link between dactylitis and complications from psoriatic arthritis. For example, a 2015 study found that people with psoriatic arthritis who also had dactylitis had a higher risk of future cardiovascular events, such as heart attack or stroke.

The reason for this may be that dactylitis is a sign of more advanced disease progression in people with psoriatic arthritis.

Early treatment can help prevent permanent damage to the joints.

Doctors may use a combination of medications to help control dactylitis, including anti-inflammatory drugs and corticosteroids.

The next line of treatment might include disease-modifying antirheumatic drugs (DMARDs) or biologics. According to research in the journal Open Access Rheumatology, biologics are more effective than DMARDs.

Biologic drugs include:

Doctors may prescribe DMARDs if the person cannot use biologics or these medications are ineffective.

If dactylitis does not respond to standard treatments, doctors may recommend anti-tumor necrosis factor (anti-TNF) drugs.

Home remedies

Some home remedies may help support treatment as well. People can try:

  • using cold packs to reduce pain
  • using warming treatments, such as warm soaks or warming gels
  • performing gentle hand or foot exercises to keep the digits moving
  • doing activities that require gentle movement in the affected digits, such as picking things up with the toes or knitting

Dactylitis causes painful swelling of an entire digit, such as a finger or toe. It is a characteristic sign of psoriatic arthritis and can indicate increasing disease severity. Dactylitis requires early diagnosis and treatment to prevent damage to the joints in the digit.

Anyone noticing signs of dactylitis should speak with their doctor. Even in cases of known psoriatic arthritis, new symptoms such as dactylitis may be a sign that current treatments are not controlling symptoms.

Managing both psoriatic arthritis and dactylitis effectively may help prevent permanent damage to the joints.