Psoriatic arthritis can cause nail problems ranging from mild to severe. Find out how to spot signs of trouble, explore treatment options, and protect your nails every day.
Psoriatic arthritis is best known for the damage it can do to your joints, but changes to your nails — both fingernails and toenails — can also signal that something is amiss inside your body.
Nail problems are a predictor of psoriatic arthritis as well as a common symptom, according to Francis C. Luk, MD, a rheumatologist at Wake Forest Baptist Health in Winston-Salem, North Carolina. He describes a condition called pitting: “It can look as though someone took a sharp pin and just punctured the nails multiple times. That’s a sign that psoriatic arthritis is going to develop, if it hasn’t already, ” he says.
Nail Disease In Psoriatic Arthritis
According to a 2017 review published in the journal Reumatologia, approximately 80 percent of people with psoriatic arthritis experience some nail damage. The effect of psoriatic arthritis and psoriasis on nails and nail beds is an often overlooked but potentially devastating complication.
“Nail involvement in psoriatic arthritis can range from very mild nail pitting all the way to severe dystrophic nail changes” that include extreme alterations in color and shape, says Neha Shah, MD, a rheumatologist and clinical instructor in the department of immunology and rheumatology at Stanford Health Care in Palo Alto, California.
Psoriatic disease can cause complex nail issues, so doctors may need to try different treatment strategies, and possibly more than one at the same time. The National Psoriasis Foundation suggests setting realistic goals; because nails grow slowly, it may take 6 to 12 months to see improvement.
How Does Psoriatic Arthritis Affect Nails?
“Besides working with a rheumatologist to treat the underlying psoriatic arthritis, which is the best way to treat nail involvement, patients should follow commonsense nail care to help prevent trauma to the nail bed that could trigger more inflammation, ” says Dr. Shah.
Nails affected by psoriatic arthritis can break easily, and trauma can exacerbate or trigger a flare-up of symptoms. Taking steps to protect your nails is key. The American Academy of Dermatology offers a few tips that can help:
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When psoriatic arthritis symptoms are under control, you may be tempted to stop taking your medication. Here’s why that’s a bad idea.Psoriatic arthritis (PsA) causes a combination of skin-related symptoms that can manifest in different ways. Some patients have scaly skin plaques on their scalp or knees while others may have pitted, ridged, or crumbling on their fingernails or toenails. Although psoriasis-related nail changes might seem like more of a cosmetic concern, it can actually be an indicator of serious issues. In fact, a new study shows that PsA patients with nail symptoms may have more severe disease compared to those whose nails appear normal.
For the study, which appeared in the Journal of Rheumatology, scientists reviewed the data of 2, 841 psoriatic arthritis patients who enrolled in the Corrona PsA/Spondyloarthritis Registry between March 2013 and October 2018.
Psoriatic Arthritis And Nails: Changes And Treatment
The researchers, led by Philip Mease, MD, of Swedish Medical Center and the University of Washington in Seattle, found that more than 40 percent of patients in the registry had nail psoriasis when they entered the study — and that nail issues were highly correlated with lower quality of life scores. People with nail problems were also more likely to report worse pain, fatigue, and trouble performing work and everyday activities.
According to their findings, patients with nail psoriasis had higher disease activity than those without nail psoriasis, including higher tender and swollen joint counts and worse disease activity score values. They also had an increased likelihood of having enthesitis (inflammation where tendons and bones connect) and dactylitis (swollen fingers or toes).
The authors noted that the initial presence of nail psoriasis may have been underreported in the study, and that information on duration and subtypes of nail psoriasis was not captured. Though they encourage future studies to take this information into account, the authors believe this study helps to “highlight the burden of nail psoriasis in patients with PsA.”
Do I Have Psoriatic Arthritis? What Symptoms To Look For
The authors also addressed several treatments that may directly help with nail psoriasis — including topical medications and corticosteroid injections, as well as disease-modifying antirheumatic drugs and biologics — and that health care providers ought to take nail condition into account when selecting or adjusting PsA treatment.
“These findings emphasize the importance of identification and management of nail disease in patients with PsA, ” they concluded. “Further research is needed to assess whether nail disease affects treatment response in patients with PsA.”
Mease PJ. Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry.
Psoriatic Arthritis Early Signs: 11 Signs And Symptoms To Watch For
Is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We represent patients through our popular social media channels, our website , and the 50-State Network, which includes nearly 1, 500 trained volunteer patient, caregiver and healthcare activists.If you have psoriatic arthritis (PsA), chances are good that it’s affected your nails. Not only is nail psoriasis an early sign of PsA, it’s the most common symptom of the disease. Psoriatic arthritis is a type of inflammatory arthritis that occurs in some people with psoriasis, a condition that causes the overproduction of skin cells, which often results in dry red patches with thick silvery scales.
Up to nearly 90 percent of people with PsA have nail involvement. “Both fingernails and toenails can be affected, and it can affect one nail or all 20 nails, ” says Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine. But considering how distorted nails can become when you have psoriatic arthritis, even one affected nail can be one too many.
These depressions on the nail are the most common symptom of PsA, occurring in more than two-thirds of people with the disease, according to the Psoriasis and Psoriatic Arthritis Alliance. They can be small and shallow or big and deep.
Psoriatic Arthritis Nail Changes: Symptoms And Treatments
This is the gradual (and, thankfully, painless) separation of a nail from the underlying nail bed. The pocket created can form a pathway for bacteria or fungi to infect the nail bed. About one-third of people with nail psoriasis develop a fungal infection.
The buildup of skin cells creates a flaky or chalky substance (doctors often refer to it as debris) that accumulates under the nail. It’s more of an issue in toenails because the constant pressure from wearing shoes can become uncomfortable.
Inflammation of the matrix, the area at the base of the nail where the cells that produce new nail growth are produced, can cause these grooves and ridges that run lengthwise and are known as Beau’s lines. They usually occur on every fingernail or toenail.
Enthesitis, Enthesopathy And The Nail In Psoriatic Arthritis
Skin and nails are made of the same protein, so the rapid, excess growth of skin cells can also cause nails to grow too quickly and/or too thickly.
White, yellow, or brown discoloration and/or reddish marks (aka splinter hemorrhages, which are caused by tiny burst blood vessels under the nails) are common among people with psoriatic arthritis.
The good news is that there are many treatments for nail psoriasis: The two mainstays are topical steroids and the vitamin D-based treatment calcipotriene. Treatments like biologics and retinoids — which work throughout the body — can also treat both your skin and nails.
Nail Psoriasis: What It Is, Causes, Nail Pitting, Treatment
The bad news is that treating nail psoriasis can be tough as, well, nails. The condition can be stubborn, so you may need to use more than one treatment. Nails also grow slowly, so even if a treatment works, it can take a while — up to a full year for fingernails, and two years for toenails, to grow out — before you’ll see the full benefit. That can be a long time to wait when your nails look distorted.
Damage or injury to the nails can cause or worsen nail psoriasis. Any sort of physical trauma can lead to what’s called the Koebner phenomenon. This is when you get a flare where the skin or nail has been injured. Keeping nails short can minimize trauma from everyday tasks. It can
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