10 Facts About Dactylitis (Sausage Fingers)

Dactylitis refers to an intense swelling of an entire digit (toe or finger). It’s often referred to as a "sausage digit" because that’s what it looks like. The swelling makes your fingers appear puffy and the joint definition isn't visible, so they look, well, sausage-like. But no matter what you call it, the condition is caused by inflammation of all of the tissues around your joint, including the skin, the tendons, and the synovium or lining of the joint.

Dactylitis is most commonly linked to PsA, but it’s not clear why. One thought is that since most people with PsA also have psoriasis, it may be skin-related. “It may have something to do with the fact that psoriasis involves the skin and other soft tissues while rheumatoid arthritis is generally confined to the joints and synovium,” says Stuart Kaplan, M.D., a rheumatologist at Northwell Health in Hewlett, NY. As Dr. Kaplan suggests, dactylitis can also affect people who have rheumatoid arthritis, and also ankylosing spondylitis, reactive arthritis, Reiter's syndrome, inflammatory bowel disease-related arthritis, and a handful of infections.

If your fingers and toes are persistently swollen, it’s very important to inform your doctor as quickly as possible. If you’re already taking medication to control your PsA and are experiencing this swelling, your medication may not be controlling your disease well. “The more aggressive the treatment, the more you can prevent future episodes,” says Dr. Kaplan.

Initially, patients with dactylitis are given non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections to treat it. “This rarely suffices for the long term,” Dr. Kaplan says. “In most cases, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and/or biologics will be necessary.” So the best way to prevent dactylitis is to keep your underlying PsA under control—either in remission or in low disease activity—and the good news is, dactylitis usually responds well to the treatment.

Besides taking your medications, which, FYI, may take a few weeks to a few months to work, the other things you can do to relieve the swelling in your fingers or toes is to use a cold pack or place your hands and feet in cold water, suggests Nilanjana Bose, M.D., a rheumatologist in Galveston, TX. Wearing compression gloves can also be helpful in relieving pain as these gloves work to warm up swollen stiff hands and joints and may even help tamp down inflammation.

Stress, smoking, alcohol—all of these things can contribute to flare-ups. In addition, if you don’t take your medication on time (or if you change your medication), you may experience a dactylitis flare, Dr. Bose says. In fact, even if you take your medications, stress can trigger swelling as stress (both emotional and physical) can exacerbate autoimmune diseases, though it isn’t super clear why.

While you can’t entirely prevent dactylitis, one thing you can do is avoid fried and processed foods because they can produce ‘advanced glycation end’ products, which cause inflammation, Dr. Kaplan says. Instead, aim to eat an anti-inflammatory diet that includes such foods as whole grains, lean proteins, and fresh produce, suggests Rajat Bhatt M.D., a rheumatologist in Houston.

Exercise helps, too. (You knew this was coming right?) When you have dactylitis, it’s important to stay physically active, says Dr. Bhatt. Consider a short walk or a dip in the pool since the majority of your body weight is supported when you swim and that weightless support can work wonders to help you cope with painful joints. “Swimming also reduces stiffness and pain by increasing your range of motion and strength,” he says.

It’s easy to say and harder to do, but since anxiety and stress can make your dactylitis symptoms feel worse, it’s worth working on some calming strategies. In fact, stress is one of the most-common PsA triggers. “I’ve found that trying meditation or doing yoga may help patients feel better,” Dr. Bhatt says. Other things you can do to reduce stress: Listen to relaxing music, take a warm bath, and get a good night’s sleep.

When it comes to dactylitis, researchers continue to see improvements with new therapies. A recent small clinical trial showed that combining a tumor necrosis factor inhibitor with methotrexate was better than methotrexate alone for dactylitis, says Ana-Maria Orbai, M.D., assistant professor of medicine and director of the psoriatic arthritis program at Johns Hopkins University School of Medicine in Baltimore. “Ultimately, understanding the dactylitis process more profoundly from a mechanistic perspective will help researchers design better therapies to treat it,” says Dr. Orbai.