Osteoarthritis Nail Changes

Changes in nail appearance and health can be perplexing and concerning, making recognising and understanding these symptoms essential. Sometimes, nail changes can be directly caused by something; other times, there may be no direct cause. These changes can provide early indicators of the disease's progression and impact on nail health.

Types of Nail Changes from Arthritis

Various nail changes can occur in individuals with arthritis, each with distinct characteristics. Understanding these changes can help in early detection and management.

Longitudinal Ridges

Longitudinal ridging involves the formation of raised lines or ridges that run along the length of the nail. These ridges can vary in depth and size, appearing as raised stripes or grooves. Longitudinal ridging is often associated with ageing and is commonly observed in individuals with osteoarthritis. It can also result from poor circulation or nutritional deficiencies. While longitudinal ridges may not cause significant discomfort, maintaining proper nail care, including moisturising and avoiding trauma, can help minimise their appearance.

Yellow Nail Syndrome

Yellow nail syndrome is characterised by yellowish discolouration of the nails, along with slow growth and thickening. Nails may appear yellow, greenish-yellow, or brownish-yellow in colour. They may also become thickened and develop a curved shape. The exact cause of yellow nail syndrome is not fully understood, but it is believed to be related to underlying health conditions such as arthritis, respiratory disorders, or lymphedema. Treatment addresses the underlying condition contributing to yellow nail syndrome. This may include managing arthritis symptoms and improving overall health through proper nutrition and lifestyle modifications.

Splinter Hemorrhages

Splinter haemorrhages are tiny blood clots that appear as small, reddish-brown lines or streaks under the nails. These lines typically resemble splinters and run vertically along the nail bed, from the base to the tip of the nail. Splinter haemorrhages can occur due to damage to the small blood vessels in the nail bed, which may be associated with inflammation or arthritis-related trauma. While splinter haemorrhages may resolve independently over time, they can sometimes indicate underlying vascular or systemic issues. Consulting a healthcare professional is advisable for proper evaluation and management.

Onycholysis

Onycholysis refers to a separation of the nail from the nail bed, leading to a gap between the two structures. The affected portion of the nail may appear white or yellowish, and the space between the nail and the nail bed may collect debris. Onycholysis can occur due to various factors, including trauma, fungal infections, or underlying medical conditions such as psoriatic arthritis or systemic lupus erythematosus. Treatment depends on the underlying cause and may include addressing arthritis symptoms, treating fungal infections, and avoiding further nail trauma.

Clubbing

Clubbing involves changes in the shape and appearance of the nails, resulting in a widened and rounded nail base. The nails may appear to bulge or curve downward at the nail base, resembling the shape of a club. Clubbing can be associated with various underlying conditions, including arthritis, lung disease, cardiovascular disorders, and gastrointestinal diseases. Treatment focuses on managing the underlying condition contributing to clubbing. In the case of arthritis, addressing joint inflammation and improving overall health may help alleviate associated nail changes.

Telangiectasia

Telangiectasia refers to the appearance of small, dilated blood vessels beneath the surface of the skin or nails. In the nails, telangiectasia may present as small red or purple lines or dots under the nail plate. Telangiectasia can result from changes in blood vessel structure and function associated with arthritis, particularly inflammatory types such as rheumatoid arthritis or osteoarthritis. Treatment focuses on managing the underlying arthritis and may involve medications to reduce inflammation and improve blood vessel health.

Koilonychia (Spoon Nails)

Koilonychia is characterised by nails that are abnormally thin and concave, resembling a spoon. The nails appear flattened or scooped out, with raised edges that may curl upwards. Koilonychia can be associated with iron deficiency anaemia, commonly observed in individuals with chronic inflammatory conditions like arthritis. Treatment focuses on addressing the underlying iron deficiency through supplementation and managing the associated arthritis symptoms.

Terry's Nails

Terry's nails refer to nails that appear predominantly white with a narrow band of reddish-brown or pinkish at the tip. The nail plate appears opaque or whitened, often with a dark band at the distal edge. The proximal portion of the nail may have a reddish or brownish hue. Terry's nails can be associated with various systemic conditions, including chronic inflammatory diseases like arthritis, liver disease, and kidney failure. Treatment involves addressing the underlying systemic condition contributing to Terry's nails and managing arthritis symptoms.

Beau's Lines

Beau's lines are transverse depressions or ridges that run horizontally across the nail plate. Beau's lines appear as indentations or grooves extending across the nail's width, often accompanied by discolouration. Beau's lines can result from temporary disruptions in nail growth due to systemic illness, severe stress, or trauma, which may be exacerbated by arthritis-related inflammation. Treatment focuses on addressing the underlying cause of Beau's lines, which may involve managing arthritis symptoms and promoting overall nail health.

Nail Plate Thickening

Nail plate thickening involves an increase in the thickness and hardness of the nails. The nails appear thicker than usual, with a hardened texture that may make trimming and grooming challenging. Nail plate thickening can occur due to chronic inflammation and changes in blood flow associated with arthritis. Treatment focuses on managing the underlying arthritis and promoting nail health through proper grooming, moisturisation, and protection.

Causes

The primary cause of nail changes in arthritis, including OA, is chronic inflammation. Inflammatory processes affect the small blood vessels and tissues surrounding the nails, leading to nail health and appearance changes. Additionally, immune system dysfunction in arthritis can directly impact nail cells and their growth.

1. Inflammation

Inflammation is a hallmark of arthritis, especially in the early stages. Inflammation can affect the small blood vessels that supply the nails, leading to various changes:

• Nail Pitting - Small depressions on the nail surface.

• Ridges and Grooves - Vertical or horizontal lines on the nails due to disruptions in the nail matrix where the nail grows.

• Discolouration - Nails may become discoloured due to altered blood flow and inflammation.

2. Altered Blood Flow

Rheumatoid arthritis can lead to changes in the blood flow around the joints, which can affect nail growth and health:

• Brittle Nails - Reduced blood flow can make nails more brittle and prone to breaking.

• Slow Growth - Nails may grow more slowly due to decreased nutrient supply.

3. Mechanical Stress

The joint changes and deformities in arthritis can lead to mechanical stress on the nails, particularly if the fingers are affected:

• Onycholysis - Separation of the nail from the nail bed can occur due to physical trauma or pressure.

• Thickened Nails - Repeated trauma or pressure can cause nails to become thicker.

4. Medication Side Effects

Medications used to manage osteoarthritis, such as nonsteroidal anti-inflammatory drugs (NSAIDs, can have side effects that affect the nails:

• Nail Thinning or Fragility - Certain medications can impact nail health indirectly by affecting nutrient absorption or causing dryness.

5. Systemic Factors

Systemic factors related to overall health and the presence of osteoarthritis can influence nail changes:

• Nutritional Deficiencies - Poor nutrition associated with chronic disease can lead to deficiencies in vitamins and minerals essential for nail health, such as biotin and zinc.

• Ageing - A primary risk factor for osteoarthritis, affects nail growth and quality. Nails tend to grow slower and may become more brittle with age.

6. Secondary Infections

Nail changes can sometimes lead to secondary infections:

• Fungal Infections - Weakened or damaged nails are more susceptible to fungal infections, leading to changes like discolouration, thickening, and crumbling.

• Bacterial Infections - Cuts or breaks in the nail bed can allow bacteria to enter, causing redness, swelling, and pain around the nails.

Symptoms

Common symptoms of arthritis-related nail changes include:

• Discolouration (yellow, brown, or red lines)

• Changes in nail thickness and texture

• Detachment of the nail from the nail bed

• Visible blood vessels under the nails

• Nail pitting or ridging

Treating nail changes associated with arthritis, particularly osteoarthritis (OA), involves addressing the underlying joint condition and specific nail symptoms. While managing arthritis is crucial, addressing nail changes can provide comfort and prevent complications. Here's a detailed look at treatments for nail changes in arthritis:

1. Medications

Topical Treatments

• Corticosteroid Creams - Applied directly to affected nails, corticosteroid creams can reduce inflammation and alleviate symptoms like swelling and redness.

• Antifungal Creams - Antifungal creams can help clear the infection and improve nail health if fungal infections are present.

Oral Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - NSAIDs can help reduce pain and inflammation associated with arthritis, which may indirectly alleviate nail symptoms.

• Antifungal Medications - Oral antifungal medications may be prescribed for severe or persistent fungal nail infections.

2. Nail Care

Regular Maintenance

• Trimming - Keep nails trimmed short to prevent trauma and reduce the risk of nail damage.

• Filing - Smooth rough edges with a nail file to prevent snagging and further damage.

• Cleanliness - Maintain good nail hygiene by keeping nails clean and dry to prevent fungal infections.

Moisturisation

• Emollient Creams - Apply moisturising creams or ointments to nails and surrounding skin to prevent dryness and brittleness.

• Cuticle Oil - Use cuticle oil to keep cuticles soft and moisturised, promoting healthy nail growth.

Gloves

• During Activities - Wear protective gloves when engaging in activities that may stress or damage the nails, such as gardening or housework.

• In Cold Weather - Protect hands and nails from cold temperatures and harsh weather conditions by wearing gloves outdoors.

Avoid Trauma

• Be Gentle - Handle nails with care to avoid trauma and minimise the risk of nail damage.

• Avoid Picking or Biting Nails - Refrain from picking, biting, or manipulating nails, as this can worsen existing nail changes.

3. Nutritional Support

Balanced Diet

• Nutrient-rich foods - Consume a balanced diet of vitamins and minerals essential for nail health, such as biotin, vitamin E, and zinc.

• Supplements - Consider taking supplements under the guidance of a healthcare professional if nutrient deficiencies are suspected.

4. Professional Treatments

Nail Procedures

• Debridement - In cases of severe nail thickening or deformity, a podiatrist or dermatologist may perform nail debridement to thin and reshape the nails.

• Laser Therapy - Laser treatments may address fungal nail infections or promote regeneration.

Injection Therapies

• Corticosteroid Injections - Corticosteroid injections may be administered directly into the affected nail area for severe nail inflammation or psoriatic arthritis-related nail changes.

5. Addressing Underlying Arthritis

Disease-Modifying Medications

• Disease-Modifying Antirheumatic Drugs (DMARDs) - In inflammatory arthritis like rheumatoid arthritis, DMARDs can help control joint inflammation and potentially improve associated nail symptoms.

Lifestyle Modifications

• Exercise - Engage in regular low-impact exercises to improve joint mobility and overall arthritis management.

• Weight Management - Maintain a healthy weight to reduce stress on weight-bearing joints and improve arthritis symptoms.

6. Monitoring and Follow-Up

Regular Check-ups

• Healthcare Provider Visits - Schedule regular follow-up appointments with a healthcare provider to monitor arthritis and nail changes, adjusting treatment plans as needed.

• Specialist Referral - Consider seeking consultation with a dermatologist or podiatrist for specialised care of nail changes associated with arthritis.

Nail changes in arthritis, while less common than joint symptoms, can provide valuable insights into the disease's impact on the body. Understanding these changes and their causes can aid in early detection and management, improving overall quality of life. If you notice significant nail changes, consult your healthcare provider for a comprehensive evaluation and tailored treatment plan.