Psoriatic arthritis (PsA) is an autoimmune disease that can cause symptoms in different parts of your body, including your hands. Some types of PsA can affect the joints in your fingers and make them bend or twist sideways. This can make everyday tasks much harder. Around 40 percent of people with PsA say it has a big impact on their daily life.

How Can Psoriatic Arthritis Affect Your Hands?

Both psoriasis and PsA can affect your hands and nails. PsA can change the shape of your hands and fingers when your immune system attacks those joints. PsA in the fingers usually affects the distal interphalangeal joints — the small joints closest to the nail.

PsA symptoms can range from mild to severe, affecting just a few joints on one side of your body or several joints on both sides. Your symptoms may also change over time.

Dactylitis

Some people with PsA develop swelling and pain in one or more fingers. This is known as dactylitis — commonly called “sausage digits.” About 40 percent of people with PsA have this symptom, which sometimes is the first sign of the disease. Chronic (ongoing) inflammation from dactylitis can lead to joint damage and cause the finger joints to become misshapen.

Enthesitis

About half of the people with PsA will experience enthesitis, or inflammation of the entheses — the areas where ligaments and tendons attach to bone. Over time, enthesitis can make the surrounding tissues ropy or hard, reducing the finger joint’s range of motion and affecting movement.

Psoriatic Arthritis Mutilans

Psoriatic arthritis mutilans is the most severe and aggressive type of PsA — but it’s also not very common. As few as 5 percent of people with PsA develop this type.

In psoriatic arthritis mutilans, severe joint inflammation causes permanent damage. In the fingers, the bones may break down, and the joints may shorten. The shortened, curled fingers may form folds of loose skin, which look like a telescope when pulled — that’s why the condition is sometimes called “telescoping fingers.” It’s also referred to as “opera-glass hands” because pulling on the fingers can also look like opening a pair of theater binoculars.

Radiographic Changes

As PsA progresses, permanent joint damage can cause your fingers to twist. These changes are radiographic changes — signs that show up on imaging tests like X-rays.

Chronic inflammation can shrink the space between your joints and lead to both bone loss and abnormal new bone production. These changes will be visible in imaging.

If you have arthritis mutilans, the “pencil-in-cup” deformity may appear. This develops when the tip of one bone wears down to a point, like a pencil, and the connecting bone hollows out, forming a cup shape.

Who Is at Risk of Changes to Their Fingers?

Certain risk factors raise your risk of psoriatic arthritis. You may be more likely to develop PsA if you have:

• Severe psoriasis
• Scalp psoriasis
• Genital psoriasis
• Psoriasis that started at a young age
• Nail psoriasis
• A family history of PsA

How Can Joint Damage Be Prevented?

Early diagnosis and proper treatment are important to help prevent permanent changes in your hands. If you notice bothersome symptoms, talk with your doctor or rheumatologist (specialist in diseases that affect the joints, muscles, bones, and immune system).

Diagnosing Psoriatic Arthritis

No single test can confirm that the changes in your hands are due to PsA. Finger and hand changes can also occur in other conditions, such as osteoarthritis, rheumatoid arthritis, and gout.

Your doctor will examine your hands and nails to look for hallmark signs of PsA, such as dactylitis and nail pitting, and check if changes are happening on just one side of your body or both. Blood tests and imaging tests can also help diagnose PsA.

Treating Psoriatic Arthritis

There’s no way to cure PsA, but the right treatment can slow its progression and help prevent further damage to your finger joints. Medications that help slow PsA include:

• Conventional disease-modifying antirheumatic drugs (DMARDs), like methotrexate
• Biologics, which target specific parts of the immune system
• Janus kinase (JAK) inhibitors, which block certain immune cell signals

Other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, help manage pain and swelling but don’t slow the disease. In some cases, surgery may be needed.

Physical therapy and occupational therapy can help with hand strength and mobility. An occupational therapist can show you hand exercises and ways to make everyday tasks easier.

You and your doctor can work together to choose a treatment plan that meets your needs and helps protect your hands.

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriatic arthritis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic arthritis.

Did your fingers change shape because of PsA? Have you had other joint-related symptoms in your hands? Share your experience in the comments below, or start a conversation by posting on your Activities page.