How Does Psoriatic Arthritis Affect Your Nails?

If you’re living with psoriatic arthritis, you know how it can affect your skin and joints. Odds are, you’ve noticed changes to your nails, too.

Fingernail and toenail differences are quite common with psoriasis and psoriatic arthritis.

People are often bothered by these nail changes, says rheumatologist M. Elaine Husni, MD, MPH. “They can be troubled by the cosmetic aspects of nail symptoms. What’s more, these changes can sometimes cause discomfort,” she says.

But like other symptoms of psoriasis and psoriatic arthritis, nail symptoms can be managed.

How common are psoriatic arthritis fingernails and toenails?

Psoriasis and psoriatic arthritis are autoimmune diseases that cause inflammation.

• Psoriasis occurs when the body’s immune system attacks your skin, causing red, scaly, inflamed patches.
• Psoriatic arthritis occurs when the immune system attacks your joints and connective tissues (ligaments and tendons). The disease causes pain and swelling in your joints, as well as fatigue.

Nail symptoms are common in people with psoriasis — and even more common in those with psoriatic arthritis. As many as 80% of people with psoriatic arthritis notice changes in their nails. In fact, nail symptoms can be an early warning sign of this type of arthritis.

How psoriatic arthritis affects your nails

Nail symptoms, it turns out, are more than skin deep.

Each of your nails is made of three components:

• Nail plate – which is the nail itself.
• Nail bed – the skin below the nail plate.
• Nail matrix – the area where your nails start growing.

“Psoriasis and psoriatic arthritis can affect all three parts of the nail,” Dr. Husni explains. “Depending on where it strikes, you can experience several different nail symptoms.”

What do nails look like with psoriatic arthritis?

With psoriatic arthritis, some people might experience changes with just a few nails while others might notice changes with all of their fingernails and toenails.

Nail changes due to psoriasis and psoriatic arthritis come in many different forms:

• Nail pitting. These small depressions in the nail plate are the most common nail symptom.
• Onycholysis. The nail detaches from the nail bed.
• Subungual hyperkeratosis. The nail bed thickens.
• Beau’s lines. Nail ridges and grooves appear.
• Splinter hemorrhages. Tiny bruises or clots appear beneath the nail and look like small splinters.
• Discoloration. Nails can be yellowish or brownish.
• Fungal infections. Nails affected by psoriasis are also more likely to develop a secondary fungal infection. (Yes, it’s adding insult to injury. But treating the infection can improve the appearance of the nails.)

Treatment options for nail psoriasis

To treat psoriatic arthritis nail changes, your doctor may prescribe topical creams or ointments to rub on your nails. Systemic medications (ones that affect the entire body) to treat psoriasis or psoriatic arthritis can also help a lot. These medications might include:

• Nonsteroidal anti-inflammatory medications (NSAIDs) to reduce inflammation.
• Disease-modifying antirheumatic drugs (DMARDs) to block inflammation.
• Biologics, a special class of DMARDs, which target specific parts of your immune system that drive inflammation in psoriatic arthritis.

Psoriatic arthritis nail care tips

Treating psoriasis and psoriatic arthritis can help reduce the uncomfortable symptoms of nail psoriasis. The following tips can also help keep your nails healthy and pain-free.

• Avoid using nail polish or polish removers with harsh chemicals, as they may make your nails more brittle. Products labeled “8-free” or “10-free” are made without harsh ingredients.
• Don’t pick at your nails or cuticles.
• Keep your nails trimmed short. “Long nails are more likely to catch on things and crack or peel back,” says Dr. Husni.
• Protect your hands. Wear gloves when doing dishes or yardwork to keep them dry and protected from damage.

Managing the symptoms of psoriatic arthritis can be a handful. With some TLC, you can keep those hands healthy. Toes, too.