How Psoriatic Arthritis Affects Hands, Fingers, and Nails

Psoriatic arthritis (PsA) can cause symptoms in many parts of your body. That includes your hands, fingers, and nails. In these areas, the disease can make everyday tasks like cooking or opening a water bottle a challenge. But the right treatment and lifestyle choices can improve your symptoms or make them easier to live with.

Psoriatic Arthritis in Your Hands and Fingers

Swelling inside the joints of your hands can make them stiff and sore. You may have swelling outside of the joints, too. These symptoms may affect one hand more than the other.

PsA can also make your fingers swell up, so they look like little sausages. It’s a condition called dactylitis, or “sausage digits.” It’s caused by inflammation in the tendons near your finger joints. You usually have it on just a few fingers but not always the same ones on each side.

A few people have the most severe form of PsA called arthritis mutilans (AM). It causes inflammation that destroys tissue and bones in your fingers. This changes how they look and makes them hard to move. They might also become shorter. AM gets worse over time. It can happen quickly or little by little.

Help for Hands and Fingers

Medicines you take for PsA can control inflammation and ease swelling and aches in your hands and fingers. The type of treatment you need depends on your symptoms and how severe they are. For example, sausage digits often happen in people who have severe PsA, so your doctor may recommend a strong medicine like a biologic.

You can also do a lot on your own to get relief.

  • Try cold packs. To bring down swelling, wrap a bag of frozen veggies or ice cubes in a soft towel. Place it on your hand for 10 minutes on, then 10 minutes off. You can do it for up to an hour.
  • Take work breaks. When you’re writing or typing, give your hands a rest every 30 minutes or so.
  • See a physical or occupational therapist. They can show you new ways to do things that don’t hurt your hands.
  • Go for gadgets. Some tools are made especially for sore hands, like easy-grip pens and nonslip jar openers. Your doctor or physical therapist can tell you where to find them.
  • Do hand exercises. These keep your hands and fingers strong and flexible. You can find examples online or ask your physical therapist to show you some.

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Nails and PsA

It’s very common for people with PsA to have changes in their nails, called nail psoriasis. It’s often one of the first signs that you have the disease. The changes can take many forms. Your nails might crumble or come away from your finger. You might notice ridges, tiny dents called pits, spots of blood, or a yellow or brown color.

The same inflammation that causes other symptoms of PsA leads to nail psoriasis, too. The type of nail problem you have depends on where the inflammation is. Inflammation where your nail and fingertip meet can cause the nail to peel away. If it’s under the cuticle, your nail might crumble.

Your nails also offer clues about PsA in the rest of your body. For example, blood spots under your nail can mean you have a lot of swollen joints. Nails that crumble or have ridges could mean you have more joint pain than other people with PsA.

Doctors have lots of ways to treat nail changes, including creams and ointments you rub on your nails, lasers, corticosteroid shots, and UVA light. Your doctor might also prescribe meds that treat your nails along with other PsA symptoms. But nails grow slowly, so you won’t see results right away. You also might need to try a few treatments to find some that work for you.

To get the most from your treatment:

  • Keep your nails short.
  • Wear gloves when you work in the house or yard.
  • Use rich creams and ointments to keep your skin moist.
  • Don’t trim your cuticles or pick at your nails. That can cause a flare.
  • Stay away from artificial nails. Nail polish and buffing are OK.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on March 29, 2019

Sources

SOURCES:

National Psoriasis Foundation: “Make cooking easier when you have psoriatic arthritis,” “Classification of Psoriatic Arthritis,” “5 things you didn’t know about PsA.”

American Academy of Dermatology: “What is nail psoriasis, and how can I treat it?” “7 nail-care tips that can reduce nail psoriasis.”

American Academy of Orthopedic Surgeons: “Arthritis of the Hand.”

UpToDate: “Psoriatic arthritis (Beyond the Basics).”

The Arthritis Foundation: “Ten Hand- and Foot-Care Tips for Psoriatic Arthritis.”

Melissa Peavy, senior hand therapist, RPSC Hand Therapy Center, Rockwall, TX.

Annals of the Rheumatic Diseases: “Dactylitis in psoriatic arthritis: A marker for disease severity?

Rheumatology News: “Dactylitis signals more severe psoriatic arthritis.”

The Journal of Rheumatology: “Comprehensive Treatment of Dactylitis in Psoriatic Arthritis.”

Lorinda Chung, MD, associate professor of medicine and dermatology, Stanford University School of Medicine.

American Society for Surgery of the Hand: “Psoriatic Arthritis.”

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