Can Rheumatoid Arthritis Affect Your Nails?

Yes, rheumatoid arthritis can affect the appearance of your nails. People living with the condition more frequently report nail ridging and thinning, which can cause easy breakage.

Rheumatoid arthritis (RA) is an inflammatory form of arthritis that primarily affects the small joints of the hands and feet. It also causes systemic, or whole-body, symptoms that might affect other areas of your body.

Although not very common, RA can affect your nails, which might include changes in growth, texture, and color. Certain nail symptoms could also be a side effect of medications used to treat RA.

Some nail changes can affect everyday activities, like cooking, eating, cleaning, and bathing. More visible nail changes might also make you feel self-conscious or affect your well-being.

Most nail changes don’t cause pain and don’t need treatment independently from the underlying RA.

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How are your nails assessed?

Your rheumatologist may evaluate your nails using sight, touch, and light.

According to Dr. Saimun Singla, a pediatric rheumatologist at Rheum to Grow in Houston, Texas, “There are multiple ways to assess nails. The first, and simplest, is visual inspection looking for discoloration or structural abnormalities.”

Singla explains the next assessment “would be palpation of the fingernails to feel for texture and consistency, such as ridging.”

“The last step is to evaluate the circulation for microvascular issues related to autoimmune disease,” she says. “This can be done with capillaroscopy, or even a simple otoscope.” These tools can help doctors get a closer image of your nails and surrounding tissue.

There are several nail conditions your doctor might determine from this assessment.

Telangiectasia, or ‘spider veins’

Telangiectasia does not affect the nails directly but can occur when small blood vessels near the surface of the skin dilate. It’s sometimes called spider veins.

This might occur and be visible on the nail bed, which is the flat tissue underneath your nails, or around the nail folds, which are the edges of nails.

Sometimes, laser treatments can minimize the appearance of telangiectasia, but treating the underlying RA should reduce their appearance.

In one 2017 study that included 111 participants living with RA, 9.9% of them presented with telangiectasia around the base of their nail beds.

Longitudinal ridging

Longitudinal nail ridging, also known as onychorrhexis, is a more common finding in people living with RA.

A 2023 study found that the chances of nail ridging were significantly increased in those living with RA.

This may look like lines or ridges that run along your nails, parallel to the fingers. The appearance of these may vary from faint lines to noticeable divots.

Treatment usually involves addressing the underlying RA, but this may take several months as the nail needs to grow out completely.

Some people living with RA report that this finding also causes nail weakness and thinning overall.

Clubbing

You may experience clubbing of your nails, which is when the nail becomes wider and rounder and starts to curve down over the tip of your finger. They might appear or feel sponge-like.

Nail clubbing is usually a sign of poor oxygen levels over a long period of time. In people living with RA, it could occur if you have an underlying related lung disease.

According to Singla, clubbing can be a clue for her to look for lung involvement in RA, such as interstitial lung disease or chronic obstructive pulmonary disease (COPD).

An older study from 1997 with 50 participants found that nail ridging and nail clubbing were significantly associated with RA. Other nail changes were not frequent enough to be statistically significant.

Rheumatoid vasculitis

Rheumatoid vasculitis is a rare complication of RA. It occurs when inflammation extends beyond the joints to affect blood vessels. This damages these blood vessels, which could cause sores around your nails.

Rheumatoid vasculitis may appear as swelling or ulcerations in the nail folds, which are the areas that protect the nail edges.

However, rheumatoid vasculitis is quite rare. Only about 1 to 5% of people with RA experience it.

Splinter hemorrhages

Splinter hemorrhages are tiny blood spots under the nail that may appear as red or brown lines. They look almost like a splinter, hence the name.

Splinter hemorrhages are infarcts of the small vessels. Infarcts indicate tissue death or damage due to inadequate blood supply to the affected area. This causes small amounts of blood from the damaged blood vessels to become visible through the nail.

They might be more likely to appear if you have rheumatoid vasculitis, or could indicate this condition.

Treatment for the underlying RA should stop them from recurring.

Yellow nail syndrome

Yellow nail syndrome is a rare condition but has been associated with RA. It involves slow-growing, thick, and yellow nails.

If you have yellow nail syndrome, you may also experience lung infections and swelling of the lymphatic system. This can be more serious and require specific treatment. So, be sure to mention this to your rheumatologist if you notice your nails are slow-growing, yellow, and thick or very hard.

RA could cause yellow nail syndrome, but research also suggests it could be a side effect of certain medications used to treat RA.

Learn more about yellow nail syndrome.

Onycholysis

Onycholysis is when the nail lifts from your nail bed, causing a white mark under the nail.

Although this can happen if you’re living with RA, it’s more commonly found in people with psoriatic arthritis (PsA).

There are a number of nail conditions that might affect PsA more than RA and vice versa. To find out more about conditions associated with PsA, check out this resource.

Thinning

Although thin nails are not well documented in medical literature, there are many reports of this finding in people living with RA.

Chronic, systemic inflammation may cause thinning nails.

What treatments can help your nails?

Treatments for nail changes related to RA usually include treating the underlying disease. This might include lifestyle changes or medications, such as methotrexate.

You can take extra care of your nails by applying moisturizers and practicing nail hygiene by keeping your nails trimmed and clean.

Avoiding exposure to chemicals and very hot water may also help improve the health and appearance of your nails.

Some people living with RA find using a nail strengthener or nail hardener from their local drug store helps, too.

These nail care and hygiene tips will be particularly effective to try and protect your nails from any cracks or breakage due to ridging or thinning.

Some frequently asked questions

Does RA affect your nails in different ways than other types of inflammatory arthritis?

Nail changes are more common and may present differently in people living with psoriatic arthritis (PsA), often due to its association with psoriasis. For example, you might be more likely to develop nail pitting with PsA in comparison to nail ridging and clubbing with RA.

Can your nails fall off with RA?

The nails falling off is very rare and not a well-documented finding in people living with RA. While some changes to your nails can occur, they are not common symptoms. Treating the underlying RA and keeping up with good nail self-care can help prevent any nail changes.

What are some of the first signs that RA might be impacting your nails?

Any changes to the color, texture, or shape of your nails and the surrounding tissue might indicate that RA could be impacting your nails.

How else can RA affect your hands?

RA typically affects the small joints of your hands and feet, including the fingers, knuckles, and wrists. This can result in inflammation, pain, and more permanent joint damage.

Can RA affect your fingernails and toenails differently?

RA doesn’t appear to affect your fingernails and toenails with different symptoms. While studies might focus on fingernails generally, there’s often no distinction made. In general, fingernails often show more changes than toenails.

Conclusion

RA primarily affects the small joints of the hands and feet. It can cause swelling, pain, and possible long-term joint damage. RA may also cause nail changes.

This can be one symptom that indicates your RA is having a systemic effect on your body.

If you’re living with RA and notice new nail changes, make an appointment with your rheumatologist. They can help you ensure your current treatment plan is as effective as possible and change it, if needed.

*All quotes were shared with permission.