Effects of Psoriatic Arthritis on the Hands, Nails and Feet

Overview of Psoriatic Arthritis

Psoriatic arthritis is a progressive and chronic form of inflammatory arthritis that can cause joint stiffness, joint pain and swelling.(1,2,3,4) Psoriatic arthritis is an autoimmune disease that is closely related to psoriasis, which is another autoimmune condition. If you have psoriasis, you are at an increased risk of developing psoriatic arthritis.(5) In fact, it is estimated that around 30% of people who have psoriasis will go on to develop psoriatic arthritis.(6) An early diagnosis of this condition can help lower the risk of having permanent joint and bone damage.

Effects of Psoriatic Arthritis on the Hands, Nails and Feet

Psoriatic Arthritis and Its Effect on Hands and Fingers

Psoriatic arthritis commonly affects the hands or fingers. This causes swelling and stiffness of these joins. In some cases, the fingers can become so swollen that they start looking like sausages, a condition known as dactylitis.(7) It is estimated that at least a third of people with psoriatic arthritis experience dactylitis in at least one finger.(8)

Swollen and stiff fingers from psoriatic arthritis often make it difficult for people to perform their daily tasks such as unscrewing a jar, buttoning their clothes, or even zipping up something. If you are experiencing such challenges for the first time, you must inform your doctor at once as these are usually indications that the severity of your condition is increasing.

Effects of Psoriatic Arthritis On Nails

A 2007 study estimated that around 87 percent of people with psoriatic arthritis experience moderate to severe nail symptoms. This condition is also referred to as nail psoriasis. (9,10)

Symptoms of nail psoriasis include:

  • Thickening or pitting or the nails
  • Discoloration, usually browning or yellowing of the nails
  • Chalky buildup under the nail
  • Pain or tenderness in the nails
  • Separation of the nail from the nail bed, a condition known as onycholysis(11)

Often, the symptoms of nail psoriasis can appear to be a fungal infection. However, the treatment for fungal infection is different than that for nail psoriasis. This is why it is essential to determine which condition you have so that the correct treatment protocol can be followed. Your doctor will take a skin cell sample from your nail and send it for testing to determine whether it is a fungal infection or nail psoriasis.

In many cases, it is possible to experience both conditions at the same time. This is because people with nail psoriasis are more prone to getting a fungal infection.(12)

Effects of Psoriatic Arthritis on the Feet

People with psoriatic arthritis often find that their feet are sore, swollen, and stiff. In some cases, it may even be painful to stand or walk for extended periods of time. You may also find it uncomfortable to wear shoes.

Some of the other symptoms of psoriatic arthritis that affect the feet include:

  • Swelling in the toes, especially of the big toe, a condition known as dactylitis
  • Swelling in the ankle
  • Pain in the Achilles tendon, a condition known as enthesopathy or enthesitis(13)
  • Pain in the bottom of the heel, known as plantar fasciitis(14)

These symptoms may come and go, which is why many people do not notice the symptoms until they become severe. However, it is important that you take note of such symptoms – the earlier, the better. If the condition is left untreated, there is a possibility of permanent foot deformity. The toes may slowly transform to become claw-like, the foot joints may become stiff permanently, and the big toe may also become elongated.

If you have psoriatic arthritis, your doctor is likely to recommend that you visit an occupational or physical therapist to learn certain stretches and exercises that will help you avoid putting stress on your feet, keep your joints flexible, and protect your joints.

Other Common Symptoms of Psoriatic Arthritis

The symptoms of psoriatic arthritis vary from person to person. The severity of the symptoms also varies accordingly. Apart from the symptoms that affect the feet and hand, here are some of the other most common symptoms of psoriatic arthritis:

  • Stiffness that is particularly bad in the morning
  • Back pain
  • Tenderness or pain in the joints
  • Swollen and warm joints
  • Decreased range of motion
  • Nail changes such as cracking and pitting
  • Fatigue
  • Eye problems such as irritation, redness, and increased sensitivity to light

The most common form of psoriatic arthritis is asymmetric arthritis, which means it affects different joints on each side of the body. Most other types of psoriatic arthritis, though, typically involve the leg and arm joints.(15) It is estimated that only around one-third of psoriatic arthritis affects the hips and spinal cord.(16)

Home Remedies for Psoriatic Arthritis Symptoms Affecting Hands and Feet

There are a number of things you can try at home to relieve the symptoms that affect your hands and feet. Besides the home remedies, once your diagnosis has been made, your doctor will help you develop a treatment plan that is customized to your symptoms and needs. Besides following the treatment plan, here are some things you can do to find relief in your hands and fingers:

  • Massage the affected parts.
  • Take regular breaks if you are writing or typing throughout the day.
  • Apply a cold or hot compress to help lower the swelling.
  • Wear hand splints to help protect and stabilize the wrist and fingers.
  • Keep doing hand and wrist exercises regularly to stretch and strengthen these muscles.

At the same time, apart from following the doctor’s treatment plan, you also need to be proactive when it comes to taking care of your nails. In people with nail psoriasis, any type of nail injury can further worsen psoriasis and trigger a flare-up. This is why it is essential to take care of and protect your nails and hands. Here are some tips to help take care of your nails:

  • Moisturize your nails after soaking them in warm water.
  • Keep your nails short.
  • Use clear nail polish as colored polish tends to hide any signs of disease.
  • Wear gloves while doing housework, cleaning the dishes, or gardening. This reduces the chances of injury.

However, make sure that you don’t soak your hands for too long and do not wear nail polish at all if you already have a nail infection. You should also avoid pushing your cuticles back too much or aggressively, as this may leave tiny tears in the skin, which may worsen.

When it comes to taking care of your feet, you can wear shoe inserts to take the pressure off your feet. Using a walking aid will also enhance your stability and avoid any falls and injury. It is important that you wear the right kind of footwear. Here are some things to keep in mind when buying a pair of shoes:

  • Avoid tight footwear. Footwear should be roomy to accommodate any swelling in the feet. You don’t want to keep buying new shoes every time your feet are swollen.
  • Choose open-toed shoes if you find closed-toed shoes tight.
  • Make sure that the shoe offers proper arch support.
  • Buy shoes made from breathable materials such as canvas.

Conclusion

If you are experiencing symptoms of psoriatic arthritis on your hands and feet, you should immediately have it checked by your doctor. The earlier you begin treatment, the better your chances are of avoiding permanent damage to your joints.

Joint damage due to psoriatic arthritis can happen quickly, without you coming to realize it. In fact, a study found that up to 50% of all people with psoriatic arthritis experience an 11% rate of joint damage or joint erosion within the first two years being diagnosed.(17)

It is important to remember that psoriatic arthritis is a progressive and chronic disease, and there is no cure yet for this condition. However, there are many effective treatment options for psoriatic arthritis, including occupational and physical therapy, that can help alleviate your symptoms. There is a lot of research going on into new medications and therapies for helping people with psoriatic arthritis. You can always check with your doctor about whether you would be the right candidate for any of these new possibilities.

References:

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  2. Gladman, D.D., Antoni, C., Mease, P., Clegg, D.O. and Nash, P., 2005. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Annals of the rheumatic diseases, 64(suppl 2), pp.ii14-ii17.
  3. Ritchlin, C.T., Colbert, R.A. and Gladman, D.D., 2017. Psoriatic arthritis. New England Journal of Medicine, 376(10), pp.957-970.
  4. Gladman, D.D., Shuckett, R., Russell, M.L., Thorne, J.C. and Schachter, R.K., 1987. Psoriatic arthritis (PSA)-an analysis of 220 patients. QJM: An International Journal of Medicine, 62(2), pp.127-141.
  5. SCARPA, R., ORIENTE, P., PUCINO, A., TORELLA, M., VIGNONE, L., RICCIO, A. and ORIENTE, C.B., 1984. Psoriatic arthritis in psoriatic patients. Rheumatology, 23(4), pp.246-250.
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  7. Brockbank, J.E., Stein, M., Schentag, C.T. and Gladman, D.D., 2005. Dactylitis in psoriatic arthritis: a marker for disease severity?. Annals of the rheumatic diseases, 64(2), pp.188-190.
  8. Leung, Y.Y., Tam, L.S., Kun, E.W. and Li, E.K., 2007. Psoriatic arthritis as a distinct disease entity. Journal of postgraduate medicine, 53(1), p.63.
  9. Tan, E.S., Chong, W.S. and Tey, H.L., 2012. Nail psoriasis. American journal of clinical dermatology, 13(6), pp.375-388.
  10. Rich, P. and Scher, R.K., 2003. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. Journal of the American Academy of Dermatology, 49(2), pp.206-212.
  11. Sobolewski, P., Walecka, I. and Dopytalska, K., 2017. Nail involvement in psoriatic arthritis. Reumatologia, 55(3), p.131.
  12. Ventura, A., Mazzeo, M., Gaziano, R., Galluzzo, M., Bianchi, L. and Campione, E., 2017. New insight into the pathogenesis of nail psoriasis and overview of treatment strategies. Drug Design, Development and Therapy, 11, p.2527.
  13. Girolomoni, G. and Gisondi, P., 2009. Psoriasis and systemic inflammation: underdiagnosed enthesopathy. Journal of the European Academy of Dermatology and Venereology, 23, pp.3-8.
  14. Salvarani, C.A.R.L.O., Cantini, F., Olivieri, I., Macchioni, P., Niccoli, L., Padula, A., Ferri, S. and Portioli, I., 1997. Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. The Journal of rheumatology, 24(6), pp.1106-1110.
  15. Sankowski, A.J., Łebkowska, U.M., Ćwikła, J., Walecka, I. and Walecki, J., 2013. Psoriatic arthritis. Polish Journal of Radiology, 78(1), p.7.
  16. Dermnetnz.org. 2020. Psoriatic Arthritis | Dermnet NZ. [online] Available at: <http://www.dermnetnz.org/topics/psoriatic-arthritis/> [Accessed 24 November 2020].
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