Epistemis

Dactylitis

Specialty: Musculoskeletal.

  • fingers in sausage
  • diffuse inflammation of the finger
  • global digital swelling

Why it occurs

  • Psoriatic arthritis (more classic association due to combined entheseal and synovial inflammation)
  • Seronegative spondyloarthritis (including ankylosing spondylitis and reactive arthritis)
  • Tophaceous gout or acute pseudogout
  • Infectious flexor tenosynovitis (surgical emergency)
  • Sarcoidosis (lupus or sarcoid dactylitis)
  • Vaso-occlusive crisis due to sickle cell anemia (common in infants)

Initial workup

High resolution musculoskeletal ultrasound with Power Doppler (assesses flexor tenosynovitis, enthesitis and hydrarthrosis) | Plain radiography in AP and oblique projections of hands/feet | Acute phase reactants (CRP, ESR) | Immunological screening (Rheumatoid factor, anti-CCP antibodies, HLA-B27).

red flags

Intense erythema with lancinating pain and absolute inability to actively flex the finger, fever, history of a puncture wound on the palmar aspect (infectious suppurative tenosynovitis; risk of tendon necrosis).

Standard management

  • Indomethacin — 50-75 mg every 12 hours orally; High potency non-steroidal anti-inflammatory for inflammatory crises
  • Methotrexate — 15-25 mg subcutaneously once a week, associated with folic acid, for background systemic management
  • Adalimumab — 40 mg subcutaneous every 14 days; anti-TNF therapy for refractory dactylitis in psoriatic arthritis
  • Cefazolin (1-2 g IV every 8 hours in case of documented pyogenic infectious etiology).

Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.

PreviousPathological joint crepitation
Area
Musculoskeletal
Listed causes
6
Treatment options
4
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