Can Rheumatoid Arthritis Cause Nail Changes?

Curated by Claudia Shannon / Research Scientist / ishonest

Rheumatoid arthritis (RA) is a chronic autoimmune condition that can affect your:

  • joints
  • organs
  • energy level

If you have RA, your immune system becomes overactive and attacks healthy parts of your body leading to inflammation and fatigue. RA may even lead to changes in your nails, such as the development of vertical ridges or a yellowing and thickening.

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Changes to your nails can be signs of RA or other systemic conditions and should be diagnosed by a doctor.

Most nail changes from RA do not need to be treated independently from the condition. RA can be managed with medication, and treatment may improve changes to your nails. If left untreated, RA can damage your joints and the bones that surround them permanently.

Nail changes

Changes to your nails may be a symptom of RA or another condition.

Nail changes related to RA are generally not painful and do not require specialized treatment. One 1997 study found that longitudinal ridging was significantly associated with RA and noted that those with RA could experience other nail changes, but those were not as consistent.

Longitudinal ridging
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Longitudinal ridging, or onychorrhexis, is when your nails have lines that run parallel from the bottom to the top of the nail. These lines create subtle or deep grooves along the nail.

You may seek treatments beyond RA management for the ridging to protect your nails, though nail ridging alone is not treated with a topical. What you can do at home is take care of your nails by applying moisturizers, avoiding exposure to harsh chemicals, and practicing nail hygiene by keeping your nails trimmed and clean.

Yellow nail syndrome

Yellow nail syndrome occurs when your nails become thicker and yellow in color. The white half-moon shapes at the bottom of your nail may disappear. The sides of the nail may begin to curve.

This condition can occur if you have RA. According to the National Organization of Rare Disorders, research suggests it might occur due to certain medications used to treat RA, but further studies are needed. Ask your doctor or a dermatologist for treatment options to try that are right for your specific situation.

Splinter hemorrhages
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Red streaks or lines under your nails might be the sign of splinter hemorrhages. Capillaries leaking under the nail cause these lines. You could develop these from RA, but nail trauma, nail fungus, and health conditions like endocarditis can also be causes.

Splinter hemorrhages may disappear with time or grow out with your nail. RA treatment may take care of recurring splinter hemorrhages.

Onycholysis

This condition occurs when your nail lifts from the finger bed and leaves a white mark under the nail. You might experience this with RA, but onycholysis is mostly associated with psoriatic arthritis.

Clubbing

There is a chance your nails may experience clubbing from RA if your lungs are affected. Clubbing occurs when your nails begin to curve downward as they grow. This creates swelling in your fingers. Your nails may feel like a sponge.

Telangiectasia
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This condition affects your nail beds and not your nails themselves. It happens when blood vessels dilate and are visible near the skin’s surface. It may be referred to as spider veins. It can also occur with other autoimmune conditions like lupus and scleroderma.

There are treatments for spider veins, such as laser therapy and surgery, but you should also seek treatment for the underlying condition if you experience spider veins at the bottom of your nails.

Pictures

Here are some images of nail changes associated with RA.

RA vs. psoriatic arthritis

Nail changes in RA are not detrimental to your quality of life, unlike some nail changes caused by psoriatic arthritis. Psoriatic arthritis is an autoimmune condition that affects the skin and joints and can cause nail lesions. According to one study, up to 80 percent of people with psoriatic arthritis develop these lesions.

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Psoriatic arthritis can also cause nail conditions including longitudinal ridges, splinter hemorrhages, and pitting.

Other symptoms

Changes to the nails could be a symptom of RA, but there are other more severe RA symptoms that impact your overall health, including:

  • swollen, tender, red, and stiff joints on one or both sides of your body
  • fatigue
  • weakness
  • slight fever
  • weight loss
  • shortness of breath

You may experience worsening symptoms with untreated RA or when you experience a flare.

Treatments

Your doctor will recommend a treatment plan to manage your RA, which may address the nail changes if they are caused by overactivity of your immune system. If you have noticeable nail changes that do not respond to your RA medications, talk with your doctor about other treatment options.

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RA treatments vary from person to person. Some medications used to treat RA include:

  • disease-modifying anti-rheumatic drugs (DMARDs)
  • biologics

Lifestyle adjustments like exercise, rest, and changes to your eating pattern may also help reduce flares and RA symptoms alongside treatments prescribed by your doctor.

When to seek care

RA is a chronic condition that requires medical treatment. Changes to your nails along with other symptoms may be signs of the condition. Talk with your doctor about your symptoms, including those affecting your nails.

The bottom line

Changes to your nails could be a sign of RA or another condition. You should discuss them and any other symptoms with a medical professional.

RA is a chronic condition that requires medical treatment, which can help reduce symptoms and improve your quality of life.

Read more on: arthritis, nail


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