Category Archives: lumps on finger joints

What’s a “sausage finger” or “sausage toe”?

Many types of arthritis can cause a sausage digit.  The technical term for this is “dactylitis.”sausage-toe

This is not the kind of sausage you would have with your eggs and pancakes.

Sausage digits are typically seen in conditions such as psoriatic arthritis (the arthritis that accompanies psoriasis), Reiter’s disease, inflammatory bowel disease, and occasionally ankylosing spondylitis.  Of these, psoriatic arthritis is probably the most common culprit. Dactylitis means inflammation of an entire finger or whole toe.

It is caused by inflammation involving the synovium (lining of the joint) as well as the lining of the tendon sheath.  Tendons are tough fibrous bands that connect muscles to bones.  Most tendons glide through a lubricated sheath lined with synovium. When the synovium in the joint and the tendon sheath becomes inflamed, the entire finger or toe will swell.

The tendons that are most often affected are the tendons that allow a person to bend or flex their fingers or toes.

If a patient has dactylitis, their prognosis is poorer in that the joints are more likely to sustain damage.  The presence of dactylitis indicates a greater chance for disease progression.

Early on, dactylitis may be extremely painful.  However, over time, as destructive changes occur, the inflamed tissue is replaced with bony deformity and the dactylitis no longer causes severe pain.  However, the swelling persists.

The presence of dactylitis should prompt a diagnostic workup.  Diagnosis can be substantiated by magnetic resonance imaging (MRI).  Recently, diagnostic ultrasound has also been found to be helpful.

The treatment of dactylitis depends on the number of digits affected.  If only a few fingers or toes are involved, ultrasound-guided steroid injection can be helpful for the acute situation.

However, the more important part of treatment is to initiate disease modifying therapy as soon as possible.

Generally, the dactylitis is often accompanied by enthesitis.  This is inflammation at tendon insertions such as the Achilles tendon, patellar tendon (the tendon that connects the kneecap to the tibia-lower leg bone, and the iliac crest.

Every disease that causes dactylitis is a systemic disease.  This is because the underlying pathology involves an abnormal immune response. So other organ systems can become affected.  An example is the eye where uveitis- inflammation of the middle layer of the eye- can occur.  Uveitis is a potentially serious complication that can lead to blindness.

Institution of drugs like methotrexate or sulfasalazine (Azulfidine) may be useful.

However, most patients will require the use of biologic therapies.

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Arthritis Treatment: New approaches to treating gouty arthritis

Gout is a common cause of arthritis affecting more than 8 million Americans.  Although it affects men more than women, there appears to be an increasing incidence of the disease in post-menopausal women. The incidence overall appears to be increasing as a result of the epidemic of obesity, hypertension, diabetes, and elevated lipids, all of which are associated with gout.

Gout, in 90 per cent of cases, is caused by the inability of the kidneys to get rid of urate.  In the other 10 per cent, there is an overproduction of urate.

Animals other than humans don’t get gout because they have an enzyme called uricase which breaks urate down and allows the animal to excrete it. Human beings, on the other hand, lack this enzyme and therefore are unable to excrete urate (uric acid) appropriately.  This leads to accumulation of uric acid crystalsuric-acid-crystals in the joints and other organ systems.

Gout typically occurs in three stages.  The first stage is what is called “asymptomatic hyperuricemia.”  Asymptomatic hyperuricemia is characterized by elevate blood uric acid levels without attacks of gout.  The higher the blood uric acid level is, though, the greater likelihood of an eventual attack.

The second phase or stage is termed “acute intermittent gout”.  During this stage, patients have attacks of gout but after the attack is over, they are relatively symptom free.  The danger here is that chronic inflammation persists despite the absence of symptoms.gouty-arthritis

The third stage is called “chronic tophaceous gout.”  In this phase, patients have chronic pain due to repeated attacks of gout with an increasing burden of urate accumulation in the joints, kidneys, and other organs systems.  Patients develop tophus“ tophi” which are deposits of inflammatory cells, uric acid crystals and fibrin. Gradual destruction of the joints occurs with the development of crippling deformity. Tophi can cause lumps on finger joints in addition to other areas.

The treatment of gouty arthritis consists of a two-fold approach with relief of the acute attack accompanied by attempts to lower the urate burden.

Acute attacks can be treated with colchicine, non-steroidal anti-inflammatory drugs, and steroids.  The latter can be given either orally or directly into the affected joint.

Drugs that lower uric acid need to be used for the chronic treatment of gout.  These drugs, when initiated, need to be accompanied by gout prophylaxis in the form of daily doses of either colchicine or non-steroidal anti-inflammatory drugs, for at least six months.  The reason is this: as urate shifts as a result of the effect of uric acid lowering drugs, there is a predisposition to acute attacks.

Drugs used to lower uric acid consist of medicines that make patients urinate out their uric acid (probenecid), medicines that suppress uric acid production ( allopurinol, febuxostat [Uloric]), and uricolytic drugs.  An example of the latter is pegloticase (Krystexxa), which converts uric acid to allantoin, an inert ingredient that is then excreted.

Counseling a patient in regards to lifestyle and diet also plays a role in the comprehensive approach to gout.

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Lump on finger joint

One of the most searched terms on the Internet is “lump on finger joint.”  This is obviously a problem that concerns many people.  Well… there’s good news and bad news about this.hand

Most lumps on finger joints are benign.  In people pas the age of thirty, lumps appearing on the middle row and last row of finger joints are called Bouchard’s and Heberden’s nodes.  These are bony swellings  due to osteoarthritis.

Osteoarthritis is the most common form of arthritis. That’s the bad news.  The good news is that while these lumps can be disturbing because of their presence as well as the fact they can be sore, these lumps usually do not cause crippling deformity.  Occasionally, particularly in the Heberden’s nodes, a gelatinous material can be expressed from the swollen joint.

Rheumatoid arthritis can also cause lumpy finger joints but here the swelling is much more evident in the joint rather than on the joint and is accompanied by significant generalized morning stiffness all over as well as fatigue. Longstanding rheumatoid arthritis causes rheumatoid nodules on the fingers.  These are collections of inflammatory cells and fibrous tissue.

Gout is another cause of lumps on the finger joints.  These lumps are called “tophi” and consist of collections of monosodium urate crystals, inflammatory cells, and fibrous tissue.

People with elevated blood lipids can develop lumps on the finger joints due to the accumulation of cholesterol.

Plant thorn synovitis is a condition caused by the puncture of a rose thron into the joint.  This leads to infection in the joint and is an unusual but dangerous cause of lumps on the finger joint.  This is considered a surgical emergency.

Unusual diseases like histiocytosis can also cause lumps.

Rarely, malignancy can do this.

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