How Psoriatic Arthritis Affects the Joints in the Fingers and Toes

Psoriatic arthritis (PsA) is an inflammatory condition that affects many joints throughout the body. One of the main areas affected by PsA is the distal joints. These are the joints closest to the nails in the fingers and toes.¹

How does PsA affect the fingers and toes?

There are several ways PsA can affect the fingers and toes:^2-5

• Dactylitis – Inflammation and swelling of the entire finger or toe, causing a sausage-like appearance. This is the hallmark feature of PsA progression and severe PsA. It occurs in about 40 percent of people with PsA.
• Enthesitis – Inflammation at the attachment points of the ligaments and tendons. This affects roughly 50 percent of people with PsA.
• Nail dystrophy – Damage to the nail beds or nail lesions. This can be an early indicator of more joint inflammation to come. It occurs in about 80 percent of people with PsA. Keep a close eye on any nail and toenail changes.
• Arthritis mutilans – Severe form of the disease that causes deformity of the hands, fingers, or toes. This is a much more rare outcome. It occurs in only about 5 percent of people with PsA.

What are the symptoms?

Symptoms of PsA in the fingers and toes include:^1-4

• Stiffness, especially first thing in the morning or after resting
  Painful joints
• Swelling, sometimes to the point that the finger or toe looks like a sausage
• Tendon or ligament pain. This may show up in the heel (Achilles tendinitis) or at the bottom of the foot (plantar fasciitis).
• Reduced range of motion
• Nail changes. These may appear as grooves that run side to side, white spots, detachment of the nail from the bed, discoloration, tenderness, nail crumbling, or nail pitting.
• Occurrence on only one side of the body (asymmetrical). For example, all the joints in one finger on the left hand may be affected, while the fingers on the right hand are unaffected. PsA can also be symmetrical, with the same joints affected on both sides of the body.

What are the treatment options?

There are many treatment options for joint problems associated with PsA. Treatment will depend on several factors, like:⁶

• Which parts of your body are affected
• The severity of your symptoms
• Which symptoms are most bothersome
• Your overall health and whether you have other health concerns

For mild PsA and minor joint pain in the fingers and toes, non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and swelling. Steroid injections can be used as well.^4,6

For moderate to severe PsA, treatments that target joint disease can reduce symptoms and prevent disease progression. Some recommended treatment options are:^4,6

• Disease-modifying anti-rheumatic drugs (DMARDs) – drugs that help calm your symptoms, slow down the disease, and prevent or slow joint damage
• Biologics – drugs that fight inflammation. These are often prescribed for PsA.
• Anti-tumor necrosis factor (TNF) agents – TNFs are substances that create inflammation in the body. Anti-TNF agents may be used if DMARDs or biologics are not working.

Talk with your doctor to understand which treatment options they recommend for you.

A healthy lifestyle can help with finger and toe joint pain

In addition to PsA treatment prescribed by your rheumatologist, you can adopt some healthy lifestyle habits. These include:^7,8

• Eat a balanced diet. If you are overweight, weight loss can help ease pressure and inflammation in the joints, including the fingers and toes. Eating a balanced diet of protein, vegetables, and whole grains while cutting out sugar and processed foods can reduce inflammation. A healthy anti-inflammatory diet may help anyone feel better.
• Try gentle movement. Gentle exercises like walking and yoga are good for the whole body. They also can ease pain and discomfort, and maintain joint mobility.
• Reduce stress. Stress reduction methods can take many forms, such as meditation, yoga, and breathing exercises.
• Get plenty of sleep. Aim for at least 7 hours of sleep every night.