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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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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.