Psoriatic arthritis, commonly referred to as PsA, has the potential to affect the nails, leading to alterations such as pitting and detachment. Therapeutic interventions often involve medications that target and alleviate inflammation.
Typically, the manifestation of psoriasis on the skin precedes the onset of PsA symptoms. Nevertheless, there are instances where individuals may experience arthritis-related symptoms prior to any skin changes. In addition to joint inflammation, PsA can also have an impact on the nails.
The concept of PsA
Psoriatic arthritis (PsA) is an inflammatory condition that intertwines the joint inflammation characteristic of arthritis with the tell-tale scaly plaques caused by psoriasis on the skin and scalp. The National Psoriasis Foundation notes that roughly 30% of individuals who have psoriasis may also develop PsA, with cases ranging from mild, impacting only a few joints, to severe, involving multiple joints. Additionally, PsA has the potential to compromise nail health.
Nail psoriasis often emerges as a precursor to PsA. Research from 2017 highlights that about 80% of those with PsA present with nail abnormalities, marking it as a common early indicator of the disease.
The Impact of PsA on Nail Health
Psoriatic arthritis (PsA) can lead to an array of nail complications, the origins of which are not entirely understood. However, several contributing elements are suspected, including:
- Genetic factors
- Environmental triggers
- Immune system functionality
PsA may also be linked to the behavior of human leukocyte antigens (HLA), specific proteins within your cells.
The Presentation of PsA in Fingernails
Not every individual with PsA will exhibit symptoms in their nails, but some may observe one or more of the following alterations:
- Pitting: Abnormal growth of nail cells can create deposits that, when dislodged, leave behind holes or indentations. These can be perceptible to touch, creating a bumpy sensation. Nails continue to grow despite these pits.
- Separation: Inflammation of the nail bed might cause the nail to detach, either in small areas or across the entire nail. This separation often presents as clear or white spots.
- White spots: These appear due to psoriatic lesions within the nail matrix – the area responsible for new nail cell formation. This symptom usually centralizes within the nail.
- Discoloration: Debris accumulation underneath the nails can make them appear as if stained by oil, typically with shades ranging from pink to purple.
- Red spots: Visible within the lunula – the whitish crescent at the nail’s base – these spots’ exact origin is unclear but may suggest the formation of new blood vessels.
- Flaking: Excessive inflammation or skin cell production in the nail bed may result in the nails crumbling or peeling off in layers.
- Ridges: Any damage to the nail matrix can lead to pronounced vertical ridges along the nails, felt as raised striations.
- Splitting with purple spots: Ruptured blood vessels can cause bleeding into tiny splits in the nail, generally along a ridge, producing what’s known as a splinter hemorrhage. Dark spots along the ridges can be indicative of this.
- Infections: Vulnerabilities in the nail, such as those caused by splitting or crumbling, may increase the risk of bacterial infections like paronychia, or fungal infections, as they become more exposed to pathogens.
How do you manage Psoriatic Arthritis-related nail issues?
Nail complications stemming from Psoriatic Arthritis are often alleviated with standard treatments, especially oral medications aimed at reducing inflammation and preserving joint integrity.
Standard PsA medications encompass:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs, including ibuprofen (Advil, Motrin) and naproxen (Aleve), alleviate inflammation and pain.
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs are designed to hinder the progression of PsA and prevent joint damage, with options like apremilast (Otezla), leflunomide (Arava), methotrexate (Trexall), and sulfasalazine (Azulfidine).
- Biologic agents: These cutting-edge arthritis medications, created through genetic engineering, specifically target bodily inflammation.
There are also treatments specifically for nail afflictions, such as:
- Cortisone injections: Although primarily for individual joints, these can be injected into the nail bed to ease inflammation and treat psoriatic lesions.
- Steroid cream: A topical treatment prescribed by your doctor to apply directly on the affected nails.
- Light therapy: This treatment involves using ultraviolet light to decelerate skin cell formation, which can be done at home with specialized equipment or at a medical facility for nail psoriasis.
- Antifungal medications: For fungal nail infections, a topical antifungal cream may be prescribed.
- Antibiotics: Oral antibiotics may be necessary for bacterial nail infections.
Taking care of PsA nails at home can be made easier with some simple practices. To manage nail psoriasis symptoms, consider the following tips:
- Maintain cleanliness and keep your nails trimmed.
- Use a mild, unscented moisturizer on your hands and feet.
- Protect your hands with gloves while doing chores or washing dishes.
- Steer clear of long soaks in hot water to prevent dryness.
- Gently clean under the nails with a soft-bristled nail brush rather than sharp tools.
- Refrain from biting or picking at your nails and surrounding skin.
- Treat hangnails with care and apply antibiotic ointment when needed.
- Make sure any nail treatments are done in a clean environment.
- Opt out of artificial nails.
- Consult your doctor before trying any natural remedies, like turmeric, for inflammation reduction. The efficacy of herbal remedies is not guaranteed, and they may interact with other medications.