Nail Symptoms with Psoriatic Arthritis Could Be a Clue to Higher Disease Activity

Psoriatic arthritis (PsA) causes a combination of skin-related symptoms that can manifest in different ways. Some patients have scaly skin plaques on their scalp or knees while others may have pitted, ridged, or crumbling on their fingernails or toenails. Although psoriasis-related nail changes might seem like more of a cosmetic concern, it can actually be an indicator of serious issues. In fact, a new study shows that PsA patients with nail symptoms may have more severe disease compared to those whose nails appear normal.

For the study, which appeared in the Journal of Rheumatology, scientists reviewed the data of 2,841 psoriatic arthritis patients who enrolled in the Corrona PsA/Spondyloarthritis Registry between March 2013 and October 2018.

The researchers, led by Philip Mease, MD, of Swedish Medical Center and the University of Washington in Seattle, found that more than 40 percent of patients in the registry had nail psoriasis when they entered the study — and that nail issues were highly correlated with lower quality of life scores. People with nail problems were also more likely to report worse pain, fatigue, and trouble performing work and everyday activities.

According to their findings, patients with nail psoriasis had higher disease activity than those without nail psoriasis, including higher tender and swollen joint counts and worse disease activity score values. They also had an increased likelihood of having enthesitis (inflammation where tendons and bones connect) and dactylitis (swollen fingers or toes).

The authors noted that the initial presence of nail psoriasis may have been underreported in the study, and that information on duration and subtypes of nail psoriasis was not captured. Though they encourage future studies to take this information into account, the authors believe this study helps to “highlight the burden of nail psoriasis in patients with PsA.”

The authors also addressed several treatments that may directly help with nail psoriasis — including topical medications and corticosteroid injections, as well as disease-modifying antirheumatic drugs and biologics — and that health care providers ought to take nail condition into account when selecting or adjusting PsA treatment.

“These findings emphasize the importance of identification and management of nail disease in patients with PsA,” they concluded. “Further research is needed to assess whether nail disease affects treatment response in patients with PsA.”

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