Dactylitis

A. Sandhya -

The immune system of the body responds to illnesses, infection and injuries through a process called inflammation. Inflammation causes swelling, pain, and other physical changes while the body is fighting an infection.
The severe inflammation of the finger and toe joints is called Dactylitis or ‘Sausage Finger’.
The word dactyl comes from the Greek word "daktylos" meaning "finger". In its medical term, it refers to both the fingers and the toes.
Dactylitis causes swelling in one or more fingers or toes, and often in the entire hand or foot and the swelling gives the fingers a bloated, sausage-like appearance.
Dactylitis is often the result of an autoimmune disorder and it can be a symptom of several different medical conditions.

The primary symptoms of Dactylitis are swollen, painful digits, and difficulty in moving the affected areas.
The inflammation causes a heavy, hot feeling in the joints, incredible pain in hands when anything is touched.
It gives the feeling as though the nerves are being compressed by the swelling and are unable to bend or use their fingers.
If dactylitis is severe, fingers become so rigid that one can no longer make a fist.

Aetiology

Dactylitis is caused by uncontrolled inflammation that results from the flaring of the underlying joint disease.
Any disease or infection that causes inflammation may cause dactylitis.
Dactylitis can occur in seronegative arthropathies, such as psoriatic arthritis and ankylosing spondylitis, in sickle-cell disease as result of a vaso occlusive crisis with bone infarcts, and in infectious conditions including tuberculosis, syphilis, and leprosy.
In reactive arthritis, sausage fingers occur due to synovitis. Dactylitis may also be seen with sarcoidosis.
The most common causes of swollen fingers or toes include:
1. Sickle cell disease
Sickle cell disease is a genetic disorder of the red blood cells which affects oxygen transport to tissues by sickle shaped red blood cells. The lack of oxygen in the tissues causes sudden, severe pain
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.
2. 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.
3. Leprosy
Leprosy is another disease that can cause similar changes in the fingers.
4. Sarcoidosis
Sarcoidosis is an inflammatory autoimmune disease that can affect the heart, liver, kidneys, lungs, and other organs. Very rarely, sarcoidosis can affect the bones and muscles of the hands, causing painful swelling.
5. Syphilis
Syphilis is a sexually transmitted infection (STI) which may cause inflammation in the bone and tissue, and usually, affects both sides of the body. In rare cases, babies born with congenital syphilis can develop dactylitis of the fingers or toes.
6. Spondyloarthritis
Spondyloarthritis refers to types of arthritis that affect the spine, 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 is common in spondyloarthritis, affecting about a third of people with the condition and it can sometimes be a sign of advanced psoriatic arthritis.
Rheumatoid arthritis (RA) causes symmetric patterns of swelling in the body and the hands and feet.
Dactylitis caused by psoriatic arthritis (PsA) does not have symmetrical joint involvement and individual digits may swell differently. For example, if the left hand may be inflamed, the right will be unaffected.
Psoriatic arthritis (PSA) and Rheumatoid arthritis (RA) are autoimmune diseases in which the immune system attacks healthy tissue. This can trigger painful, damaging inflammation to joint and tendon sheaths.
7. 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.
Skin infections, such as Streptococcus or Staphylococcus, cause infection of the fatty pad of a single finger or toe and such form of dactylitis is called blistering distal dactylitis.
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.
Infections caused by Salmonella, Shigella, Yersinia, Campylobacter result in reactive arthritis in which joints become stiff.
8. Gout    
Gout is a type of arthritis caused due to the deposition of urate crystals.
Dactylitis can be found in up to 5% of people with gout.

Management

It may be difficult to do day-to-day activities due to Dactylitis. One cannot get dressed or undressed, eat, use the bathroom, or do much of anything unassisted when this happens to both hands at the same time.
Dactylitis usually cannot go away on its own.
Careful management and monitoring can reduce the severity of dactylitis, and may prevent its recurring.
Many causes of dactylitis, however, are incurable chronic illnesses and these diseases may require ongoing treatment and management.
Some strategies for managing Dactylitis are

  • To manage inflammation: should stay physically active and eat an anti-inflammatory diet
  • To lessen the severity of symptoms : losing excess weight, reducing pressure on joints, adopting an exercise routine are needed
  • To reduce stiffness and pain, low-impact workouts such as swimming, walking, biking, yoga are to be carried out.
  • Working with a therapist: A physical therapist or an occupational therapist can help to retain some function of the small joints of the hands and cope with the physical limitations that may interfere with daily life.
  • Physical therapy and doing regular range-of-motion exercise can also improve joint function and reduce stiffness.
  • Managing anxiety: Anxiety and stress can make symptoms worse and meditation or yoga may help manage anxiety and make feel better.
  • Using cold packs or soaking hands in cold water may lessen swelling.
  • Wearing compression gloves, or finger sleeves like volleyball and basketball players use to keep pressure on the hand so fluid doesn't build up.
  • Trying warm paraffin wax, icy hot, or other warming treatments.
  • Keeping fingers moving with crochet or knitting, a stress ball, or even just flexing and releasing.
  • Skipping the salt makes the body hang on to water, which can make any swelling   worse. Instead, herbs, spices, garlic, and citrus juices can be added to add flavor to foods.
  • Lever-style faucet handles are to be installed to turn for water in the kitchen and bathroom.
  • At night, the hand and forearm are to be placed on a stack of pillows so the fluid can drain away while sleeping.
    As many of the conditions that cause dactylitis are serious, it is important that a person should visit a doctor as soon as possible for swollen fingers.