Psoriasis of the nails in PsA - it’s a thing!

Following on from my toenail query and photo this morning, it now turns out that previous studies have revealed between 80% and 90% of people with psoriatic arthritis have psoriasis of the finger and/or toenails. For all many of us don’t seem to know about it, it’s a well-established and extremely common element of the condition, and can sometimes appear very early in PsA onset. Symptoms of nail psoriasis include:

Pitting: Pitting is the most common nail symptom, affecting about 68 percent of people with psoriasis and nail changes. The nail surface may look uneven. In some cases, random indents appear in the nail.

Pink or oily patches: The skin underneath the nail may develop discolored, pink patches. The nail may appear to have trapped oil underneath it. The area can turn golden yellow or brown.

White spots: White discoloration on the nail may be a sign of damage from psoriasis or psoriatic arthritis in the nail matrix.

Onychorrhexis or brittle nails: The nails may become very brittle. They may be more prone to breaking or crumbling. In some cases, the nails may form large ridges or split at the ends.

Onycholysis: Onycholysis occurs when the nails lift or start to separate from the nail bed. A gap may form between the two, causing the nail to turn white or yellowish. As the gap extends down towards the cuticle, the nail may be prone to infection.

Hyperkeratosis: Psoriasis may cause a buildup of grey keratin cells under the nail.

Splinter hemorrhages: These are tiny blood spots or lines that appear under the nail. Damaged capillaries in the nail bed can burst and release small amounts of blood that spread.

Fungal infections: Many people with nail changes due to psoriasis or psoriatic arthritis will also experience fungal infections of the nails, such as onychomycosis.

Source: Medical News Today, Jan 2019 medicalnewstoday.com/articl...

In addition, other very reputable sources also talk about thickening of the nail as being part of nail psoriasis, and Beau’s lines, which are horizontal ridges going across the nail. The vertical ridges on nails are often a normal part of aging, and can also have other causes, but are frequently present even in young people with an inflammatory arthritis.

So there you go. I know you learn something new every day, but that one took me completely by surprise...👀😂

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Thank you CG this has been very helpful. Like you said learnt something new today 👍

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Glad it’s helped, Whaleroad! 😊

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So can this also happen due to Rheumatoid Arthritis?

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You could have psoriasis of the nails (or of the skin) and have RA as separate conditions, but it wouldn’t be a feature of RA. In psoriatic arthritis (PsA), psoriasis of the nails and/or the skin is a distinct, clinical feature of the diagnosis.