How Psoriatic Arthritis Affects Your Nails

Psoriatic arthritis (PsA) is a type of inflammatory arthritis often associated with psoriasis. It combines the painful, inflamed joints commonly seen in arthritis with the scaly patches that psoriasis causes on the skin and scalp.

About 30% of people living with psoriasis develop PsA, reports the National Psoriasis Foundation. The severity of the condition can vary. It can range from mild cases affecting only a few joints to more severe cases that involve multiple joints. It can also affect the nails.

In fact, fingernail psoriasis is sometimes an early sign of PsA. According to a 2017 research review, about 80% of people with PsA have nail lesions.

PsA can cause a variety of nail issues. While the exact cause is unclear, there are several potential factors that may play a role.

These include:

• your genes
• your environment
• how your immune system works

PsA may be related to the activity of human leukocyte antigens (HLA), which are a type of protein in your cells.

Not everyone with PsA has nail symptoms. Others may have only one or two of the following nail changes.

• Pitting: Unusual cell growth causes a buildup of deposits on your nail. When these fall off, they leave holes and dents, which might feel bumpy to the touch. Your nails continue to grow around these areas.
• Separation: This is when your nail bed becomes inflamed, causing your nails to separate in pockets or across your entire nail. When this happens, it may look like a clear or white spot.
• White spots: These occur from psoriatic lesions in your nail matrix, which is the part of the nail bed where new nail cells are made. It tends to happen in the middle of your nail.
• Discoloration: A buildup of cellular debris beneath your nails can cause your nails to look oil-stained. The exact color of these stains may vary, but they often have a pink or purple tint.
• Red spots: You may see these in the whitish half-moon near the base of your nail, called the lunula. The cause is unclear but may indicate the development of new blood vessels.
• Flaking: Inflammation or too many skin cells in your nail bed can cause your nails to crumble or flake off layer by layer.
• Ridges: Lesions in the nail matrix can cause vertical ridges up and down your nails that look and feel like raised lines.
• Splitting with purple spots: When blood vessels break and leak blood into small splits in the nail, your nail may split vertically along one of the ridges, known as a splitting hemorrhage. This may be happening if you see a dark spot along one of your ridges.
• Infections: Paronychia, a nail bacterial infection, and nail fungus can develop because splitting and crumbling can leave your nails vulnerable to germs.

PsA-related nail problems usually respond well to general PsA treatments, particularly oral medications used to reduce inflammation and protect your joints from damage.

Common medications for PsA include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs help reduce inflammation and treat pain. This class of medication includes ibuprofen (Advil, Motrin) and naproxen (Aleve).
• Disease-modifying antirheumatic drugs (DMARDs): DMARDs work to prevent PsA from permanently damaging your joints. Examples include:
  • apremilast (Otezla)
  • leflunomide (Arava)
  • methotrexate (Trexall)
  • sulfasalazine (Azulfidine)
• Biologic agents: Biologics are a newer generation of arthritis drugs formed through genetic engineering. They target inflammation in your body.

Some treatments work to target your nails directly, such as:

• Cortisone injections: Cortisone injections usually target inflammation in a single joint, but a doctor can also inject them into the nail bed to reduce inflammation and address psoriatic lesions.
• Steroid cream: Your doctor can prescribe a steroid cream for you to rub directly on your nails.
• Light therapy: Light therapy (phototherapy) uses ultraviolet light to target psoriasis by slowing skin cell growth. You can do perform it at home with special equipment or at your doctor’s office to treat psoriasis of the nails.
• Antifungal medications: If you develop a fungal nail infection, your doctor might prescribe a topical antifungal cream.
• Antibiotics: If you have a bacterial infection in your nail, you may need oral antibiotics.

Some home remedies can help alleviate symptoms of PsA in nails. Here are several things you can do to help manage nail psoriasis:

• Keep your fingernails clean and trimmed.
• Moisturize your hands and feet with a gentle, fragrance-free moisturizer.
• Wear gloves when doing manual labor or housework, such as washing dishes.
• Avoid soaking your hands and feet in very hot water, which can cause dryness.
• Use a soft-bristled nail brush instead of sharp objects to clean under the nails.
• Avoid biting or picking at your nails and the skin around them.
• Carefully attend to hangnails and apply an antibiotic ointment when necessary.
• Ensure any manicures or pedicures are done under sanitary conditions.
• Avoid wearing artificial nails.

Always let your doctor know before trying any herbal or natural remedies, such as turmeric, to help reduce inflammation. The effectiveness of herbal remedies has not been proven, and supplements can sometimes interact with medications.

When should I see a doctor for nail PsA?

If you see any signs of psoriasis or fungal infections, talk with your doctor. If you have psoriasis and notice new nail symptoms, your doctor can also help diagnose and treat the areas.

What do your hands look like with PsA?

Other than the effects on your nails, PsA can cause your fingers to swell, which is called dactylitis. It can also affect your toes.

What are the 6 signs of PsA?

There are many signs that could indicate PsA, but six early ones are nail symptoms, fatigue, lower back pain, dactylitis, eye inflammation, and joint stiffness.

PsA is frequently linked to psoriasis. It combines the stiff and inflamed joints typically experienced with arthritis with the scaly patches of psoriasis on the skin and scalp.

This condition can also affect the nails with symptoms like pitting, flaking, and ridges. Treatment options and self-care measures can help you get relief from discomfort.