Connect with others who understand.

sign up log in
Resources
About MyPsoriasisTeam
Powered By

Why Are Your Fingers Twisting Sideways?

Posted on January 23, 2023
Medically reviewed by
Zeba Faroqui, M.D.
Article written by
Amanda Jacot, PharmD

Psoriatic arthritis (PsA) is an autoimmune disease that can cause symptoms in many parts of your body, including your hands. Some types of PsA can affect your finger joints, perhaps causing them to twist sideways. When this happens, everyday tasks can become much harder to accomplish. Psoriatic arthritis symptoms in your hands can drastically affect your quality of life — around 40 percent of people with PsA say the disease is a large problem in their everyday lives.

How Can Psoriatic Arthritis Affect Your Hands?

Both psoriasis and PsA can involve your hands and nails. PsA can cause changes to your hands and fingers when your immune system attacks those joints. When PsA develops in the fingers, it usually affects the joints closest to the nail, which are called the distal interphalangeal joints.

Psoriatic arthritis can range from mild to severe, causing symptoms in just a few joints on one side of your body or several joints on both sides. Additionally, your symptoms may change over time.

Dactylitis

People who have PsA may notice one or more fingers becoming swollen, red, and painful. This is known as dactylitis — commonly called “sausage digits.” About 40 percent of people with PsA have symptoms of dactylitis, which sometimes is the first manifestation of the disease. Chronic inflammation from dactylitis can lead to changes that cause the finger joints to twist.

Inflammation from dactylitis can make fingers swell and look like sausages, leading to stiffness and limiting movement. (CC BY-NC-ND 3.0 NZ/DermNet)


Enthesitis

About half of the people with PsA will experience enthesitis, or inflammation of the entheses — the areas where ligaments and tendons connect to bone. When this happens in the hands or fingers, the inflammation can lead to dactylitis. Over time, enthesitis can cause the surrounding tissues to become ropy or hard, reducing the finger joint’s range of motion and making movement more difficult.

Psoriatic Arthritis Mutilans

People with psoriatic arthritis mutilans, the most severe and aggressive type of PsA, have severe joint inflammation that causes permanent damage. In the fingers, inflammation sometimes leads to bone deterioration and joint shortening, also known as “telescoping fingers” — the shorter, twisted fingers with overlying folds of skin resemble telescopes. The condition is also referred to as “opera-glass hands” because pulling on the fingers can look like opening a pair of theater binoculars.

Arthritis mutilans can cause bones to deteriorate and joints to shorten in fingers, sometimes called “telescoping fingers” or — because of how the fingers look when pulled — “opera-glass hands.”
(CC BY-SA 4.0/Jojo at Polish Wikipedia)

Radiographic Changes

X-rays can show the permanent changes to your joints
caused by psoriatic arthritis, such as deformities in
the fingers. (CC BY-NC-ND 3.0 NZ/DermNet)

As PsA progresses, permanent changes can occur in the joints and cause your fingers to twist. These are radiographic changes — signs that can be seen using imaging tests like X-rays.

Chronic inflammation of the joints and entheses can make the connective tissues unable to support your joints. The space between your joints can get smaller and may result in both bone loss and inappropriate bone production.

If you have arthritis mutilans, you may also see a “pencil-in-cup” deformity that develops when one side of the bone erodes into a sharp point. This point wears away the joint, and the connecting bone forms a cup shape as it’s destroyed.

Who Is at Risk of Changes to Their Fingers?

Although 30 percent of people with psoriasis will develop PsA, as few as 5 percent develop the most severe type of arthritis — arthritis mutilans. Some people have a higher risk than others of developing PsA.

People with the following risk factors may be more likely to develop PsA:

  • Severe psoriasis
  • Scalp psoriasis
  • Genital psoriasis
  • Psoriasis onset at an early age
  • Nail psoriasis
  • Obesity
  • A history of smoking tobacco products

How Can Joint Damage Be Prevented?

Early diagnosis and proper treatment are important to prevent permanent changes in your hands. Talk with your doctor or rheumatologist as soon as you notice bothersome symptoms.

Diagnosing Psoriatic Arthritis

No specific test can confirm that the changes in your hands are due to PsA. Instead, your doctor will ask you questions about your health history and run several tests, such as labs and X-rays, to help determine the cause.

Changes to your hands and fingers can occur in different types of arthritis and other diseases, 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 to see if changes are happening on just one side of your body or both. You may have blood tests and imaging tests done to help diagnose PsA.

Treating Psoriatic Arthritis

Although there isn’t a way to stop PsA, you can slow its progression and help prevent further damage to your finger joints by getting the right treatment to help prevent joint damage.

Some medications help control how fast PsA progresses. These are known as disease-modifying antirheumatic drugs (DMARDs). Other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, address only the symptoms.

Physical therapy or occupational therapy can help if daily tasks become difficult. An occupational therapist can teach you hand exercises to improve how you use your fingers.

You and your doctor will discuss which treatment option is right for you.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 114,000 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.

    All updates must be accompanied by text or a picture.
    Zeba Faroqui, M.D. earned her medical degree from the SUNY Downstate College of Medicine. Learn more about her here.
    Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

    Related articles

    Psoriatic arthritis (PsA) is an ongoing condition. If left untreated, it can get worse over time,...

    Can Psoriatic Arthritis Cause Numbness, Tingling, and Neuropathy?

    Psoriatic arthritis (PsA) is an ongoing condition. If left untreated, it can get worse over time,...
    Up to 80 percent of people with plaque psoriasis and psoriatic arthritis experience nail...

    Nail Psoriasis: Symptoms, Causes, and Treatments

    Up to 80 percent of people with plaque psoriasis and psoriatic arthritis experience nail...
    Psoriasis in the navel (belly button) is usually associated with inverse psoriasis, sometimes...

    Psoriasis in the Belly Button: Symptoms and Treatment

    Psoriasis in the navel (belly button) is usually associated with inverse psoriasis, sometimes...
    About half of people with plaque psoriasis on their bodies also develop psoriasis on the face....

    Psoriasis on the Face: Pictures, Symptoms, and Treatments

    About half of people with plaque psoriasis on their bodies also develop psoriasis on the face....
    Most people who have psoriatic arthritis (PsA) had psoriasis for five to 10 years first....

    The Connection Between Skin and Joint Pain

    Most people who have psoriatic arthritis (PsA) had psoriasis for five to 10 years first....
    Psoriatic arthritis (PsA) can cause nail problems such as discoloration, pitting, and...

    Psoriatic Arthritis and Nails: Symptoms and Treatment

    Psoriatic arthritis (PsA) can cause nail problems such as discoloration, pitting, and...

    Recent articles

    MyPsoriasisTeam members sometimes report that their inverse psoriasis has a bad smell. Inverse...

    Does Inverse Psoriasis Have a Smell?

    MyPsoriasisTeam members sometimes report that their inverse psoriasis has a bad smell. Inverse...
    Psoriasis on the buttocks is a type of genital psoriasis. Most people living with this skin...

    How To Identify and Manage Psoriasis on the Buttocks

    Psoriasis on the buttocks is a type of genital psoriasis. Most people living with this skin...
    Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most common treatments used to...

    Meloxicam for Psoriatic Arthritis: 9 Things To Consider

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most common treatments used to...
    If you have facial psoriasis and facial hair, you may find it difficult to manage your beard....

    6 Tips for Managing Psoriasis Under Your Beard

    If you have facial psoriasis and facial hair, you may find it difficult to manage your beard....
    MyPsoriasisTeam members often wonder how their diet might affect their skin condition and if...

    Carnivore Diet for Psoriasis: Is It Effective?

    MyPsoriasisTeam members often wonder how their diet might affect their skin condition and if...
    Many people might reach for ointments as a topical treatment for scalp psoriasis. Like other...

    What To Look For in Scalp Psoriasis Ointments

    Many people might reach for ointments as a topical treatment for scalp psoriasis. Like other...
    MyPsoriasisTeam My psoriasis Team

    Thank you for subscribing!

    Become a member to get even more:

    sign up for free

    close