Everybody gets swollen fingers or toes sometimes. When your fingers or toes are so puffy that they look like sausages -- and they hurt, too -- you need to see your doctor. You could have a type of inflammation called dactylitis, or sausage digits. It can damage your fingers if you don’t get the right treatment.
Dactylitis is common in certain types of inflammatory arthritis, including psoriatic arthritis and ankylosing spondylitis. It’s considered a hallmark of psoriatic arthritis. It can also show how severe a case of psoriatic arthritis will be. Fingers and toes usually don’t swell like this when you have rheumatoid arthritis or osteoarthritis.
Unless you have psoriatic arthritis or a high risk for inflammatory arthritis, your swollen fingers or toes probably have a different cause. Salty food, extra weight, and certain medications can make your fingers swell. So don’t assume the worst if you can’t get your ring off. But do pay attention to your swelling. Dactylitis usually won’t go away on its own.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
The first drug your doctor recommends for dactylitis will probably be a nonsteroidal anti-inflammatory drug, or NSAID. These medications ease swelling and pain.
Some, like ibuprofen (Advil, Midol, Motrin) and naproxen (Aleve), are available over the counter. Others are prescription-only. Here are a few of many examples:
While NSAIDs can ease some symptoms, they often don’t do enough to address the problem. You may need stronger medications.
Cortisone shots (injections of corticosteroids) typically come after NSAIDs. They send powerful medicine directly into affected joints to relieve pain and swelling. Your doctor may use ultrasound or a type of X-ray called fluoroscopy to guide the needle.
Like all drugs, these shots can have side effects. They include:
Because of the potential side effects, you shouldn’t get cortisone shots often. If your dactylitis doesn’t go away, you may need something stronger still.
Disease-Modifying Antirheumatic Drugs (DMARDs)
Some doctors prescribe disease-modifying antirheumatic drugs for dactylitis. These drugs target the underlying disease to slow or stop joint damage. They may also ease some symptoms.
DMARDs used for dactylitis include:
DMARDs are powerful drugs used for many types of inflammatory arthritis. But even they may not be enough to tame the inflammation in your fingers and toes.
If your fingers or toes remain swollen despite attempts at treatment (the doctor will call this resistant dactylitis), it may be time to try a biologic drug. These medications also target the underlying disease. They could be your best option to control dactylitis when nothing else works. You can take them with or without DMARDs. You get biologics as shots or in a vein (IV).
Older biologic drugs are known as tumor necrosis factor-alpha (TNF-alpha) inhibitors. A recent review of the medical literature showed these medications, as well as newer biologics, significantly improved dactylitis. This gives you and your doctor several drug options to discuss. In this review, the three biologic drugs that showed the most promise for dactylitis were:
Your doctor might also try:
Are There Natural Remedies?
You may be tempted to reduce the swelling in your fingers and toes with natural or home remedies. It would be wise to check with your doctor first. Dactylitis may be a hallmark of psoriatic arthritis, but it also happens in other diseases, including:
You’ll want to know exactly what’s wrong so you can make the best decision about treatment.
Cold therapy is usually a safe home remedy for warm, painful, swollen fingers. An ice pack, a bag of frozen vegetables, even a bowl of cold water can temporarily reduce these symptoms.