How Psoriatic Arthritis Affects the Hands

Psoriatic arthritis (PsA) causes inflammation in the joints, resulting in pain. It is often seen in people with an inflammatory skin condition, called psoriasis, although you do not have to have psoriasis to develop PsA; sometimes the arthritis develops before the skin lesions do. . The same inflammation and pain affecting the knees, hips, and back also affects the hands. In the hands, it causes swelling of the joints in the wrists, hands, and fingers and limits the ability to use those joints. It may also cause nail symptoms.

Symptoms

When PsA affects the hands, it can have a significant effect on a person's quality of life. These symptoms tend to be more intense and more upsetting, this according to the National Psoriasis Foundation. This is because pain from PsA can make even the most routine tasks hard to do and painful. A simple thing, such as shaking someone’s hand, is painful.

PsA will cause the hands and fingers to be stiff and swollen. For some people, the fingers swell so badly they take on a sausage-like appearance, a condition known as dactylitis. A 2015 article in the journal Rheumatic Diseases Clinics of North America reports around 40% of people with PsA have dactylitis at some in their disease course, and this symptom can occur in either their hands or feet. Further, about half of the people with PsA will have dactylitis in at least one digit.

The prevalence of nail symptoms (nail psoriasis) in people with PsA ranges in different studies from about 15% to 79%. Nail symptoms may include the following:

• Yellow, brown, or other discoloration of nails
• Nail thickening
• Nail pitting—shallow, deep holes in the nails
• Onycholysis—separation of a nail from the nail bed
• Chalky build up in the nails
• Nail pain or tenderness

Nail psoriasis may resemble a fungal infection. If you have nail symptoms with PsA, talk to your healthcare provider in order to determine if your nail symptoms are psoriasis-related or a fungal infection. Your healthcare provider can take nail and skin samples to test them. Treatment will depend on the cause of nail symptoms, but nail fungus is treated much differently than nail psoriasis. In some cases, a person may be experiencing both nail psoriasis and nail fungus, as people with nail psoriasis are more likely to get fungal infections.

The same inflammatory process that causes PsA symptoms and inflammation in the hands also affects the bones, muscles, tendons, and ligaments of the feet and ankles, causing pain, tenderness, and swelling. The feet, ankles, and toes may feel warm to the touch and stiffness may be worse in the morning or after prolonged inactivity. Dactylitis also affects the toes causing a sausage-like appearance of the digits. Inflammation may also affect the heels and soles of the feet. There may be toenail psoriasis, with symptoms similar to what is seen in fingernails, including pitting and discoloration.

Diagnosis

You should see your healthcare provider if joint pain and swelling in hands and fingers are making it harder to perform routine tasks and/or if you have new hand, finger, and nail symptoms. Your healthcare provider will closely examine your wrists, hands, fingers, and nails to look for swelling, stiffness, pain, discoloration and nail pitting. Questions about current symptoms, psoriasis and PsA medical history, and family history are expected.

Tests and studies include checking your blood work, as well as joint fluid and X-rays to check for joint damage and inflammation in your hands, wrists, and fingers. Your healthcare provider will want to rule other conditions that may cause similar symptoms and confirm hand symptoms are related to PsA.

It is important to treat hand and finger symptoms quickly. Joint damage in PsA happens very quickly. In fact, one study reported in 2013 in the journal Arthritis Research & Therapy finds up to 50% of people with PsA experience an 11% rate of joint erosion (i.e., joint damage or bony defects as a result of inflammation) during the first two years of the disease.

Treatment

There is no cure for PsA, but numerous therapies treat inflammation and its underlying causes. They may alter the way the immune system works, reduce symptom severity and frequency of disease flare-ups—periods of high disease activity. They also lessen the long-term impact of PsA.

Various therapies can help with managing hand and nail symptoms and may include:

• Anti-inflammatory drugs for reducing swelling, stiffness, and pain in the hands and fingers
• Corticosteroids to reduce inflammation and ease joint pain
• Creams to relieve skin symptoms and discomfort
• Anti-fungal treatments for nail fungus infections
• Phototherapy for skin flares
• DMARDs to reduce systemic inflammation and reduce the risk of both joint damage and cardiovascular morbidity and mortality
• Biologics to reduce systemic inflammation and reduce the risk of both joint damage and cardiovascular morbidity and mortality

Some people may need surgery resulting from joint damage in the hand and finger joints. Surgical treatment is dependent on the joints affected and specific symptoms experienced.

Home Remedies and Self Care

Some home remedies can help you to prevent and relieve hand and nail symptoms of PsA.

For relieving hand and finger joint pain, try:

• Applying ice to hand joints for ten minutes at a time as needed to reduce pain and swelling
• Massaging affected areas
• Wearing hand splints to support and protect wrist, hand and finger joints
• Taking breaks from writing and typing
• Performing hand exercises to stretch and strengthen the muscles and joints of the hand and fingers

For managing nail symptoms:

• Treat nail fungus infections with antifungal creams
• Avoid fake nails as they can injure nail beds
• Trim cuticles, and avoid pulling at the cuticles to avoid injuries and flares
• Keep fingernails trimmed and clean to prevent injuries
• Wear gloves when doing household chores or gardening
• Use clear nail polish in order to notice nail changes quickly
• Don’t use nail polish if you have an active nail infection

A Word From Verywell

Whether you have PsA in the hands, feet, or both, PsA can cause painful symptoms that affect the ability to engage in routine daily tasks. Make an appointment to see your healthcare provider right away if you experience pain, swelling, or inflammation in hands or feet. The sooner you treat these symptoms, the better your quality of life and long-term outlook will be.