Dactylitis and diagnosis
A woman I know is an educated patient who has worked hard to make certain she is diagnosed and treated appropriately. Recently, she showed pictures of swollen fingers to her rheumatologist and had her diagnosis changed again. Her doctor explained that the swelling in her photo looked like dactylitis or “sausage finger.”
Her new diagnosis is Psoriatic Arthritis, based upon negative Rheumatoid factor and dactylitis-type swelling. I’ve heard RA patients use the words “sausage finger” many times and seen dozens of pictures. Nothing much surprises me in rheumatology any more, but I had to ask my friend Dr. Google how prevalent the notion is that dactylitis can’t be RA. I found a 1998 article about dactylitis characterizing the viewpoint:
“Compared with the wider spectrum in children, sausage-shaped digits have only a few known causes in adults: Reiter’s syndrome, psoriatic arthritis, sarcoidosis, flexor tendon sheath infections, and gout. In our series, the presence of dactylitis eliminated rheumatoid arthritis from the differential diagnosis” (emphasis added).
A 2007 article in the Journal of Rheumatology “Dactylitis or ‘Sausage-Shaped’ Digit” maintains this opinion: “Recently, dactylitis has been included, due to its high specificity and sufficient sensitivity, in the classification criteria…” for Psoriatic Arthritis.
Here is a Johns Hopkins image of dactylitis.
Can people with RA have this type of sausage finger swelling too?
Have you? Does it have to be only one finger? And finger shapes vary. If it seems confusing, there may be good reason.
That’s because it is. It’s Too Hazy.
Two other conversations I had today seem to play in concert with this one. The topics:
1) Lupus is listed as an “immune” disease on this popular list of healthcare topics for Twitter. Rheumatoid is listed as a musculoskeletal condition with osteoarthritis, osteoporosis, tennis elbow, and fibromyalgia. I can’t sum up the 600+ pages of rawarrior.com, except to say Not So Much.
I discussed it with someone from Symplur, but it’s hard to summarize, isn’t it? If you are unsure whether Rheumatoid is a systemic disease similar to Lupus or just a type of arthritis, please read some of the articles listed below as Recommended Reading.
2) Last month the ACR published new criteria for Sjogren’s syndrome diagnosis. Today I read “Sjögren’s criteria embrace multispecialty approach” and just said Wow, Really?
The patients’ diagnosis will be judged based upon a blood test, an eye test, and a lip biopsy. I love objective evidence. But wasn’t the whole world so distressed because Venus Williams has some terrible systemic disease that makes her joints hurt and fatigues her beyond belief. Well at least we were aware for a week or so last year. No mention of these prominent symptoms in the “multispecialty approach” baffles me.
The bottom line is that we don’t have a bottom line yet. We know too little about these diseases. It’s that simple. I mean, Complicated.
Note: Statistics vary about the number, but a large portion of Sjogren’s patients are people with Rheumatoid. Until now, this was referred to as Secondary Sjogren’s syndrome. Newsflash for people with RA disease and Lupus: the Sjogren’s criteria article continued, “Furthermore, the distinction between primary and secondary forms of Sjögren’s may now be obsolete, the authors continued.”
- Preclinical Rheumatoid Disease: There Are No Joints in the Lungs
- Does It Matter Whether Rheumatoid Arthritis Affects DIP Joints?
- Will Venus Williams’ Sjögren’s Syndrome Help RA?
- What is Sjogren’s Syndrome?
- “Dealing with RA Is So Much Easier than Lupus” –Kathy Lubbers