In this video, you’ll learn what it means to have a sausage digit if you have psoriasis.
Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, where we specialize in evaluation and treatment of arthritis, tendonitis, injuries, and back pain.
Sausage digit, this is a strange but well known condition that you can see in psoriasis. To begin with, what is psoriasis? Psoriasis is an autoimmune condition that affects the skin. By auto immune condition, I mean your immune system, which is meant to normally protect you from anything foreign including bacteria and viruses, is inappropriately recognizing your own body as foreign. In the case of psoriasis, it’s specifically your immune system is recognizing your skin as foreign, and is essentially attacking it causing inflammation which then causes the skin lesions that you see classically in psoriasis.
So in roughly 20% of psoriasis patients, psoriatic arthritis can occur. Psoriatic arthritis is that same inflammatory process that you see in the skin is now occurring in the musculoskeletal system. Including in the joints, the tendons, and ligaments.
So what is a sausage digit in psoriasis? The medical name for it is called dactylitis which essentially means swelling of an extremity or finger, or toe. So specifically dactylitis or sausage digit is essentially inflammation that is occurring throughout an entire digit. And you can see that in the fingers or the toes, the specific structures that get inflamed include the joint, the tendon, and the ligaments. And because it’s all three of those structures that are swollen and inflamed, what you see is a finger or toe that is distended throughout the entire length of the digit. That’s different than what you see if you only have inflammation within the joint where it’ll only be a more specific swelling around that specific joint, rather than throughout the entire digit.
The classic presentation for dactylitis or sausage digit is swelling of a digit and if you have psoriasis. So there are a number of other conditions that can also cause dactylitis including some infections, as well as sarcoidosis, which is another type of autoimmune condition. But the classic presentation for sausage digit is still seen in psoriatic arthritis. So when should you suspect that you could have dactylitis? Well, to begin with, if you have psoriasis or the classic lesions that you see in psoriasis, and if you notice that one of your fingers or toes is completely painful and swollen.
What you should do next is essentially see your rheumatologist or at least see your dermatologist, if that’s who’s been taking care of your psoriasis. Based on an examination, there should be some suspicion that you could have a sausage digit. It has a very characteristic look to it. One that if you’re used to treating psoriatic arthritis patients, is really pretty classic and undeniable. Why I find then to really confirm that diagnosis is if right there, in the exam room, if your physician or rheumatologist can then do a diagnostic musculoskeletal ultrasound, where they specifically look at the finger or toe that is actually swollen and painful, and they can then see whether the joint, tendons, and ligaments are all swollen and inflamed. If your physician is recommending an x-ray or MRI, generally speaking, an x-ray is not going to really show you what you need to see in dactylitis. It’s only looking at the bones. You can sometimes see some chronic changes in the bones that you can see in chronic dactylitis, but it’s really not the right imaging study if you’re looking for active inflammation. An MRI can be helpful as well. But is dramatically more expensive and really unnecessary if your physician has the skills actually look at a musculoskeletal ultrasound and make that diagnosis immediately.
Treatment of dactylitis, is very similar to treatment of psoriasis. Meaning that if you’re not getting better with very conservative treatment for your psoriasis, generally speaking, your physician will escalate you to some of the newer medications that have been around for the last 25 years or so. The newer medications are biologic medications do a better job of treating psoriasis, and they can do a much better job of also treating dactylitis. So if you have a sausage digit where you have that degree of inflammation and pain and swelling, I generally will recommend that you consider one of those medications because it’s really not safe to allow that digit to remain that inflamed. The risk is that you’ll then progressively develop not only pain and inflammation, but eventually damage and more permanent damage in the joint and tendons that are actually inflamed and injured. That’ll then lead to more chronic deformities, more chronic pain, and chronic instability in that joint which then leads to other problems as well. You can treat that when it’s very inflamed with the newer medications which will then do a much better job of treating not only the active inflammation but then also preventing the progression of that condition as well.
Sausage digit, it’s a unique and strange name that we have for this condition seen in psoriasis and psoriatic arthritis. I hope this video has given you some better understanding of what’s involved in that condition, how we evaluate it, and how we can treat it.
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