If you have psoriatic arthritis (PsA), chances are you’ve experienced swollen or stiff fingers or toes. PsA may involve the small joints closest to the tips of the fingers and toes, called the distal interphalangeal (DIP) joints. More than half of people with PsA have DIP joint involvement.

PsA that mainly affects the DIP joints is known as distal interphalangeal-predominant (DIP-predominant) PsA — one of the five types of PsA. The other types are spondylitis, symmetric polyarthritis, asymmetric oligoarthritis, and arthritis mutilans.

This article provides an overview of DIP-predominant psoriatic arthritis, including what it feels like, photos, and how to treat and manage it.

What Does DIP-Predominant Psoriatic Arthritis Look Like?

The DIP joints are the joints closest to the tips of your fingers or toes, just below the nails. DIP-predominant PsA causes swelling and pain in these joints.

For many people, PsA typically begins in four or fewer joints, known as oligoarticular PsA, but it can advance and affect five or more joints — a condition known as polyarticular PsA. When more than half of the joints affected by PsA are DIP joints, the condition is known as DIP-predominant PsA. DIP involvement can also be seen in other forms of PsA. Most people diagnosed with PsA also have skin symptoms associated with psoriasis.

DIP-predominant PsA can affect one side of the body (asymmetric PsA) or both sides (symmetric PsA). Symptoms may be similar to those of other types of PsA, such as:

• Nail changes — Pitting, ridges, crumbling, or the nail plate lifting from the nail bed
• Dactylitis — Swelling of the entire finger or toe, causing a sausagelike appearance
• Enthesitis — Inflammation where the tendon attaches to the bone

Radiographic Changes

Radiographic changes can be seen using imaging tests, such as X-rays, MRIs, and ultrasounds.

Joint damage from PsA happens when inflammation destroys the bones and tendons in the joint, and new bone growth occurs inappropriately. By using an imaging test such as an X-ray, your doctor can look for changes to the bones in your hands, including:

• Bone erosion — Loss of bone, commonly seen within the first two years of PsA
• Joint space narrowing — Reduced space between the joint’s bones, causing them to rub against each other
• Pencil-in-cup deformity — Erosion of bone into a sharp point on one side of a joint and a cup shape on the other side
• Bone spurs — Bony growths in the joint, also called osteophytes

An MRI can reveal problems with the tendons and ligaments in your hands and feet.

What Does DIP-Predominant Psoriatic Arthritis Feel Like?

DIP-predominant PsA can cause joint pain and impair hand function by decreasing your range of motion, grip strength, and fine motor skills. A study from the journal ACR Open Rheumatology found that hand dysfunction in PsA was similar to that of rheumatoid arthritis.

MyPsoriasisTeam members have described how impaired hand function from PsA has affected their lives. One member shared, “My fingers hurt and are swollen. One finger is crooked. I cannot make a fist with that hand.”

Another member commented on how PsA in their hands makes it hard for them to complete daily tasks: “My hands are to the point where I can only use them to do things like eat or brush my teeth. I can’t open bottles or cans, open my medications, hold a spatula longer than a few seconds at a time, twist a lot of doorknobs, or drive farther than just a few miles.”

Who Gets DIP-Predominant Psoriatic Arthritis?

The most important risk factor for developing DIP-predominant PsA is psoriasis. About one-third of people with psoriasis develop PsA. Of those who have PsA, around 12 percent to 20 percent may have DIP-predominant psoriatic arthritis.

PsA is most commonly diagnosed in people between the ages of 30 and 50. You may be at increased risk if you have a family member with PsA. About 40 percent of people with the condition have a family history of PsA.

Diagnosing DIP-Predominant Psoriatic Arthritis

DIP-predominant PsA is diagnosed in a similar way as other types of PsA. Your healthcare provider will diagnose DIP-predominant PsA based on your symptoms, a physical exam, and imaging tests.

There isn’t a definitive way to diagnose PsA using a laboratory test. However, your healthcare provider may run tests to rule out other diseases, such as:

• Osteoarthritis
• Gout
• Reactive arthritis
• Rheumatoid arthritis

Your healthcare provider may look for signs and symptoms of DIP-predominant PsA that distinguish it from other conditions. For example, in people with DIP-predominant PsA, over 50 percent of the joints affected by PsA are the DIP joints. They may also have nail symptoms.

Additionally, DIP joint involvement is common in PsA and inflammatory osteoarthritis but not in rheumatoid arthritis. In fact, DIP involvement is frequently used in differential diagnosis between rheumatoid arthritis and PsA.

Blood tests may also help rule out other conditions on the path to diagnosing PsA.

It’s important to diagnose PsA early so you can get prompt treatment — a delay in diagnosis of just six months can increase your risk of joint damage.

How Do You Treat DIP-Predominant Psoriatic Arthritis?

There’s no cure for PsA, and there’s no way to prevent it. However, treatment can help improve your symptoms and prevent lasting joint damage from inflammation. Your treatment options will depend on the type and severity of your symptoms. Talk to your healthcare provider about what treatment for DIP-predominant PsA is best for you.

Mild DIP-Predominant Psoriatic Arthritis

If your symptoms are mild, your healthcare provider might suggest nonsteroidal anti-inflammatory drugs (NSAIDs) to control swelling and pain and help you perform daily activities. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). Stronger NSAIDs are available with a prescription.

If you have only a few joints that are affected, your doctor may inject a corticosteroid medication directly into the affected area to decrease inflammation.

Moderate to Severe DIP-Predominant Psoriatic Arthritis

Moderate to severe PsA symptoms may be treated with systemic treatments called disease-modifying antirheumatic drugs (DMARDs), which help to slow joint damage by decreasing inflammation.

Conventional DMARDs help calm an overactive immune system that may be causing joint damage. The term “conventional” is used to distinguish these drugs from newer, biologic DMARDs, which are a more recent class of medications. Conventional DMARDs are taken orally, usually in pill form.

Biologic DMARDs target specific parts of the immune system that cause inflammation in PsA. They are given by injection or infusion.

Other Therapies

In addition to medications, other types of therapy can help improve hand function and relieve pain associated with DIP-predominant PsA. Many of these therapies can be used at the same time as medical treatments. Ask your doctor if therapies such as the following might be right for you:

• Physical therapy — Helps increase strength and decrease pain
• Hot and cold therapy — May ease joint pain and decrease swelling
• Occupational therapy — Teaches you ways to make everyday tasks a little easier
• Exercise — Keeps joints limber and lowers your risk of developing related conditions, such as heart disease

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriatic arthritis, get advice, and find support from others who understand.

Do you have DIP-predominant psoriatic arthritis? Have any medical or lifestyle treatments particularly helped your symptoms? Let others know in the comments below.