How Are Joints of Fingers & Toes Affected?

Psoriatic arthritis (PsA) is an inflammatory arthritis that is associated with psoriasis. It is a chronic disease estimated to affect up to 40% of people with psoriasis.1,2 The condition affects a variety of joints, creating diversity among the patient population.3 One of the areas commonly affected by PsA are the distal joints, those closest to the nails in the fingers and toes.2

There are four distinct ways PsA can affect the fingers and toes:

  • Dactylitis – Some people with PsA develop dactylitis, an inflammation causing a sausage-shape to the fingers or toes.1
  • Enthesitis – PsA can cause inflammation at the attachment points of the ligaments and tendons.4
  • Nail dystrophy – Damage to the nail beds or nail lesions can be a symptom of PsA.4
  • Arthritis mutilans – The most severe, destructive form of PsA, arthritis mutilans is characterized by bone loss and deformation, causing shortening of the fingers or toes and leading to loss of function.5

How common is it for the fingers and toes to be affected in psoriatic arthritis?

Dactylitis occurs in up to 50% of people with PsA and is a marker for disease progression. Nail dystrophy occurs in about 87% of people with PsA, and arthritis mutilans occurs in up to 5% of PsA cases.2,5

What are the typical symptoms when fingers and toes are involved in psoriatic arthritis?

Symptoms of PsA in the fingers and toes include:

  • Stiffness, especially first thing in the morning or after a period of rest
  • Painful joints
  • Swelling, sometimes to the point of the digit looking like a sausage
  • Tendon or ligament pain, which may show up in the heel (Achilles tendinitis) or at the bottom of the foot (plantar fasciitis)
  • Reduced range of motion
  • Nail changes, which may appear as grooves that run side to side, white spots, detachment of the nail from the bed, discoloration, tenderness, nail crumbling, or nail pitting6,7,8

The affected digits can be asymmetrical, occurring on only one side of the body. For example, all the joints in one finger on the left hand may be affected while the same finger on the right hand is unaffected. PsA can also by symmetrical, with the same joints affected on both sides of the body.2

What can be done to alleviate pain or disability?

Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs (NSAIDs). In addition, injections of corticosteroids may be used.9

For moderate to severe disease, treatments that target joint disease in PsA can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs (known as DMARDs). The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor (TNF), a chemical that produces a wide range of inflammation in PsA. Examples of TNF blockers include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). Other DMARDs that have proven effective in clinical trials include ustekinumab (Stelara), brodalumab (which is awaiting FDA approval), and secukinumab (Cosentyx). 5 The FDA has also recently approved Inflectra (infliximab-dyyb), a biosimilar to infliximab, for the treatment of PsA.10

Physical and occupational therapy, involving exercises, stretching, heat, cold, and possible vocational readjustments, can be critical treatment approaches to both protect the involved joints and maintain function.6,9

When appropriate, patients may be referred for possible surgery to alleviate severe pain or damage. However, high rates of recurrent joint damage have been noted after surgery for PsA patients, particularly in the hand.6

Written by: Emily Downward | Last reviewed: October 2016.
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