Not only does rheumatoid arthritis (RA) cause painful swelling and inflammation in the joints, but it can also affect other parts of the body, like the nails. Nail changes associated with RA have been noted in studies dating back to the 1960s. Even if nail issues aren’t as painful as other RA symptoms, they can still cause discomfort and, when noticeable, feelings of self-consciousness.

This article discusses the causes of nail problems and changes in RA, treatment options, and advice from myRAteam members on how to handle these issues.

What Do Rheumatoid Nails Look Like?

People living with RA may see a variety of changes to their nails. These can result from RA, other conditions, specific medications, or treatment plans.

Nail conditions and changes seen in RA can include:

• Longitudinal ridging — Raised vertical lines on the nails
• Yellow nail syndrome — Nails grow slowly, turn yellow, and thicken
• Splintering hemorrhages — Burst blood vessels under the nails
• Onycholysis — Lifting or separation of the nail from the nail bed
• Clubbing — Enlarged nails that curve downward
• Telangiectasia — Widened blood vessels under the nails

Longitudinal Ridging

Studies have found people with RA to have longitudinal ridging in the nails. Also called onychorrhexis, this symptom causes grooves along the length of the nails. These ridges may be deep or shallow and subtle.

Yellow Nail Syndrome

As its name suggests, yellow nail syndrome happens when the nails grow thicker and yellow. You may also notice the sides of your nails curving inward or the whites of your nails disappearing. Yellow nail syndrome is a very rare condition. It can be associated with lung problems and lymphedema.

Some case reports (studies the focus on a single individual) have found yellow nail syndrome in people taking RA medications like bucillamine. This drug is used in Japan and South Korea and not approved by the U.S. Food and Drug Administration (FDA).

Splintering Hemorrhages

Splintering hemorrhages are dark streaks or lines that look like bruises underneath the nails. These hemorrhages are caused by damaged or leaking capillaries (tiny blood vessels).

Although splinter hemorrhages have been seen in people with RA, RA is not the only cause of this nail condition. Other causes include nail trauma (like stubbing your toe), endocarditis, fungus, some medications, and other health conditions, like vasculitis or Raynaud’s disease.

Onycholysis

You may experience onycholysis, where nails lift from their beds, leaving white marks underneath. Onycholysis is more commonly associated with psoriatic arthritis, but it may still affect those with RA. Fungal infections, nail trauma, and thyroid disease are other causes.

Nail Clubbing

Some people with RA experience clubbing in their nails. This causes the nails to curve downward as they grow, resulting in swollen fingers and a spongelike texture to the nails. Lung problems or cancer are more common causes of clubbing. Clubbing may happen when certain blood cells get stuck in the fingertips and release substances that make extra tissue grow. It’s not common in people with RA and is not considered a direct symptom of the condition.

Telangiectasia

Telangiectasia, also known as spider veins, happens when blood vessels in the nail beds dilate (widen). This makes them easier to see near the surface of your skin. Telangiectasia may be associated with RA and other autoimmune conditions, such as systemic sclerosis and mixed connective tissue disease. Autoimmune conditions are diseases in which the immune system mistakenly attacks the body’s own tissues. Telangiectasia can also occur with other conditions, like chronic obstructive pulmonary disease (COPD) and diabetes.

Members of myRAteam on Nail Changes With RA

Several myRAteam members have posted about their own experiences with RA-related nail symptoms.

“I also have had arthritis and migraines since childhood,” wrote one member. “I wasn’t diagnosed, but at 10, I had ridged nails, and I started to hide them with nail polish. Then, when my fingers started to twist, my nails followed through with twisting and curving.”

Another member posed a question in hopes of finding advice from others: “Can anyone tell me if they have had any changes in their nails? Mine have become fixed to the nail bed. And the nails are growing out concave. It’s weird.”

Another third member asked whether anyone else was having problems with their nails: “I mean ridges on nail, horizontal lines. I am worried, as this started last month.”

Although these changes may be worrying, it can help to know you’re not alone if you have RA‑related nail problems.

Managing Nail Changes With RA

Talk to a healthcare provider or rheumatologist about any changes to your nails with RA. Nail symptoms often don’t need specialized treatment. In some cases, you may be referred to a specialist like a dermatologist. Below are some options for managing nail symptoms.

Try Home Remedies

Members of myRAteam have recommended some at-home remedies for various nail changes.

One member’s solution to yellow nail syndrome, as well as general nail trauma and soreness, was to soak their feet in Epsom salt. After drying your feet, they recommended applying “some tea tree oil or lavender oil to your toenails. This will also help with healing.”

This member also recommended seeing a doctor for broken or damaged nails.

Practice Basic Nail Care

Although topical (applied directly to the skin) treatments alone cannot resolve nail ridging or other nail symptoms, taking proper care of your nails may ease symptoms. Applying moisturizer, limiting or avoiding nail exposure to harsh chemicals, and maintaining proper nail hygiene through regular trimming and cleaning can all help with longitudinal ridging.

Cover Nail Changes

If you feel self-conscious about deep ridges or changes in your nail color, using nail polish or gently buffing your nails may help you feel better.

Avoid Harsh Nail Treatments

Avoid harsher treatments like gels or acrylics, as these can increase the risk of nail separation and cause further damage. Tell your rheumatologist about any nail treatments you’re planning. They can let you know if anything might damage your nails or make nail problems worse.

Use Nail-Strengthening Products

You can buy over-the-counter protein lacquers and polishes that provide extra strength for your nails. There are also prescription nail treatments that may help the nail look more normal, but they don’t treat the underlying condition.

Ask Your Doctor

If you notice nail changes like yellowing, lifting, ridges, or curving, talk to your doctor. Some of these changes may be related to RA or other autoimmune conditions. In rare cases, they could be a sign of lung or heart problems. Your doctor can help figure out what’s causing the changes and what to do next.

Find Your Team

On myRAteam, the social network for people with rheumatoid arthritis, members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you had nail changes or damage with RA? How have you managed the condition? Share your experience and tips in the comments below or by posting on your Activities page.