Image reads Dactylitis or 'Sausage Fingers" the image shows fingers with swollen joints
Credit: Tatiana Ayazo

Key Takeaways

  • Psoriatic arthritis patients with dactylitis who had not yet started treatment are likely to have “a more severe disease phenotype” than patients without this symptom. 
  • More swollen joints, higher C-creative protein levels, and more joint erosions and synovitis found among patients with PsA with “sausage fingers” or toes.  
  • Researchers hope these findings urge clinicians to consider treating this group of patients more aggressively. 

Many people with various forms of arthritis have swollen joints in their hands or feet, but the swelling is usually confined to the knuckles. If you have dactylitis, however, entire digits become so swollen and painful that they might resemble mini sausages.

Dactylitis is a common symptom of psoriatic arthritis (PsA) — an inflammatory form of arthritis that’s characterized by skin psoriasis as well as joint swelling — but not everyone with PsA has it. Now a new study suggests that those who do might have a more severe form of PsA.

The research, which was published in the Annals of the Rheumatic Diseases, focused on 177 newly diagnosed PsA patients who had not yet started taking a disease-modifying anti-rheumatic drug (DMARD). Slightly fewer than half (46 percent) of them had dactylitis, most often in their toes; the other 54 percent did not.

All study participants were thoroughly examined and had ultrasounds to scan 50 of their joints. According to the findings, those who presented with dactylitis tended to have the following:

  • More swollen joints
  • Higher C-reactive protein levels
  • More joint erosions and synovitis (inflammation of the membrane that lines a joint)

Many inflammatory diseases including PsA likely have subsets of patients with unique characteristics. The authors of this study concluded that those with dactylitis likely have “a more severe disease phenotype” and that clinicians might consider treating this group more aggressively.

“This is the first study, to our knowledge, to evaluate the overall clinical and U.S. disease burden in a DMARD-naive early PsA cohort based on the presence/absence of dactylitis,” researchers wrote. The authors also concluded that the results confirmed “a greater burden of disease in PsA with dactylitis.”

The hope is that these findings shine light on the importance of tailoring therapy specific to PsA phenotypes to avoid biologic disease-modifying antirheumatic drug failure.

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Dubash S, et al. Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis. Annals of the Rheumatic Diseases. December 2021. doi