Dactylitis

What is dactylitis?

Dactylitis is inflammation of a digit (either finger or toe) and is derived from the Greek word dactylos meaning finger. The affected fingers and/or toes swell up into a sausage shape and can become painful.

What causes dactylitis?

Although any inflammatory process involving the fingers or toes may be called dactylitis, the term has been used to describe some well defined disease entities where swelling of the digits is an obvious symptom.

Type of dactylitis	Notes
Sickle-cell dactylitis (also known as hand-foot syndrome)	Occurs in patients with sickle-cell anaemia, most frequently for the first time within the first 4 years of life In many cases dactylitis is the first sign of the presence of the blood disorder and often leads to the diagnosis of sickle-cell disease Sickle-cell dactylitis is often mistaken for other diseases, especially acute osteomyelitis, cellulitis, leukaemia, and rheumatic fever
Tuberculous dactylitis	A rare manifestation of extra-pulmonary tuberculosis A variant of tuberculous osteomyelitis affecting the short tubular bones of the hands and feet Radiological findings show a central, lytic, cystic, and expansive lesion known as spina ventosa
Syphilitic dactylitis	A manifestation of congenital syphilis Similar features as tuberculous dactylitis but involvement is bilateral and symmetrical
Sarcoid dactylitis	Occurs in about 0.2% of patients with sarcoidosis, and often associated with lupus pernio (large bluish-red and dusky purple infiltrated nodules and plaque-like lesions on nose, cheeks, ears, fingers and toes) Bone and soft tissue involvement of the fingers that classically presents as bilateral, fusiform or sausage-shaped swellings
Blistering distal dactylitis	A superficial infection of the anterior fat pad of the distal portion of the finger(s), most often occurring in children Most commonly caused by group A beta-hemolytic streptococci (see Streptococcal skin infections) but also from Staphylococcus aureus
Spondyloarthritis dactylitis	A common feature in all forms of spondyloarthropathies, including psoriatic arthritis Dactylitis occurs in about one third of patients with psoriatic arthritis, with the feet being most affected Dactylitis is not a feature of rheumatoid arthritis

What are the signs and symptoms?

In children with sickle-cell disease, the first sign is usually quite sudden and is characterised by painful swelling of the hands, feet, or both. The child refuses to bear weight and has puffy, tender and warm fingers and/or toes. This is often accompanied by fever, raised white cell count and mild anaemia.

Treatment

The clinical symptoms in sickle-cell dactylitis are self-limiting. Swelling and pain usually subsides spontaneously without any medical or surgical treatment. The duration of symptoms may range from several days to a month. It rarely causes permanent damage but in some cases may result in shortening of the fingers as a result of premature fusion of the epiphyseal plates.

In other types of dactylitis, treating the cause is the main form of therapy. Dactylitis caused from infectious agents can be treated with appropriate antibiotics.

Related information

References:

Brockbank JE, Stein M, Schentag CT, et al. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 2005; 64(2): 188-90
Jadavji T, Prober CG. Dactylitis in a child with sickle cell trait. Can Med Assoc J 1985; 132: 814-815
Olivieri E, Scarano A, Padula V, et al. Dactylitis, a term for different digit diseases. Scandinavian Journal of Rheumatology 2006; 35(5): 333-340
Worrall VT, Butera V. Sickle-Cell Dactylitis. J Bone Joint Surg (Am) 1976; 58:1161-1163

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