Symptoms of Psoriatic Arthritis in the Hands

Psoriatic arthritis (PsA) is an inflammatory arthritis that can affect any joint in the body. But, for reasons that are unclear, it really likes the hands. Inflammation in the skin and nails is also common. The good news? Thanks to modern medicine, PsA is a very treatable condition!

In this article, we review what PsA can do to the hands and how to treat it.

What are the first symptoms of psoriatic arthritis?

PsA is different for every person who has it, so the first symptoms are different for everyone too. Joint pain and stiffness are common and can affect any joint in the body, including the joints in the hands. PsA can also cause inflammation of: 

• The tendons: tendonitis and enthesitis

• Entire fingers or toes: dactylitis, or “sausage digits” 

About 25% of people who have psoriasis also have PsA. Psoriasis rashes typically appear before joint pain, but sometimes rashes can show up later or at the same time. Interestingly, it’s also possible to have PsA without psoriasis, but this is rare. 

How does psoriatic arthritis affect the hands?

When PsA affects the hands, any joint can be involved. It’s common for inflammation to be asymmetric, affecting some joints in one hand and different joints in the other.

Hand joints commonly affected by PsA include:

• Carpal joints: wrists

• Metacarpophalangeal joints: knuckles

• Proximal interphalangeal joints: joints in the middle of the fingers

• Distal interphalangeal joints: joints closest to the fingernails

How to tell the difference between hand psoriatic arthritis and rheumatoid arthritis

Because rheumatoid arthritis (RA) also affects joints in the hands, it’s sometimes difficult to distinguish between the conditions. But RA leaves the distal interphalangeal joints alone. So inflammation there is a clue that you are dealing with PsA, not RA.Another symptom that can help distinguish PsA from RA is dactylitis: inflammation of all of the joints and tendons in one finger.

Symptoms of dactylitis include:

• Pain and tenderness of the entire finger

• Swelling of the entire finger (like a sausage)

• Warmth

• Redness

• Difficulty bending the finger due to swelling and tightness

What does PsA in the hands and fingers feel like?

PsA hand pain feels different for everyone, and it depends on which parts of the hand are inflamed. Symptoms can also come and go, meaning some days you feel OK and some days you don’t. 

Commonly, people experience swelling, pain, and stiffness:

• Swelling can make it hard to bend the fingers or grip things. 

• Pain can be a deep ache, throbbing, or sharp. It can be in one joint, or it can jump around from place to place. 

• Stiffness feels like you’re frozen, as if your joints need oiling. It typically takes about 30 minutes for the hands and fingers to loosen up. For some, though, it can take the whole day. 

“Trigger finger” is another symptom of PsA in the hands. With it, people experience a locking sensation followed by a popping sound as the finger moves from a bent to straight position. 

What are symptoms of psoriatic arthritis in the nails?

Because nails are a continuation of the skin, psoriasis and PsA can affect the nails, just like they do the skin. And, just like in the skin, psoriasis causes characteristic changes in the nails: 

• Tiny dents (nail pitting)

• The nail lifting up from the nail bed (onycholysis)

• Crumbling

• A buildup of thickened skin underneath the nails

• Lines and ridges across the nail

• Color changes under the nail (white, yellow, or reddish-brown)

Nail psoriasis, while treatable, can be slow to improve. That’s because nails grow so slowly. So it can take 6 months or longer for nails to start to grow back normally. 

How do you treat psoriatic arthritis symptoms in the hands?

Treating PsA symptoms in the hands is the same as treating PsA anywhere else in the body. Medications called immunosuppressants treat the underlying cause: an overactive immune system that targets the skin, joints, and tendons and causes inflammation. 

The goal of treatment is to find a medication (or combination of medications) that clears the skin and improves joint pain and swelling, everywhere you’re affected. Put another way, there is no treatment that specifically targets PsA in the hands. 

That said, finding the right treatment for PsA that affects the hands is particularly important. Left untreated, PsA can cause complications, including permanent joint damage. And when this affects the hands, it can be particularly problematic. Permanent damage to the hands can mean visible deformities and problems with all sorts of daily activities. So starting treatment early is important.

It can take some time to find the right medication(s), but there will be a treatment plan that works for you. Talk to your provider about treatment options. Together, you can find an approach that you feel comfortable with. 

Some common options include:

• NSAIDs like ibuprofen 

• Disease-modifying antirheumatic drugs (DMARDs), like methotrexate

• Biologics, like Humira or Cosentyx

• Janus kinase (JAK) inhibitors, like Xeljanz and Otezla (apremilast) 

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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