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Rheumatoid Arthritis Nail Changes: Causes and Treatment

Posted on April 06, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Megan Cawley

Not only does rheumatoid arthritis (RA) cause painful swelling and inflammation in the joints, it can also cause changes to the nails. These changes have long been understood to be caused by RA, with studies as far back as 1960 noting the symptom. Even if nail issues aren’t as painful as other RA symptoms, they can still cause discomfort and, when noticeable, make someone feel self-conscious.

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

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 wanted to know 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 or even embarrassing, it can be helpful to know that you’re not alone in dealing with RA-related nail problems.

Types of RA-Related Nail Changes and Their Causes

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

Specific nail conditions and changes seen in RA can include:

  • Raised vertical lines on the nails (longitudinal ridging)
  • Yellow nail syndrome
  • Burst blood vessels under the nails (splintering hemorrhages)
  • Lifting or separation of the nail from the nail bed (onycholysis)
  • Enlarged nails that curve downward (clubbing)
  • Widened blood vessels under the nails (telangiectasia)

Longitudinal Ridging

RA can cause longitudinal ridging in the nails. Also called onychorrhexis, this symptom causes the appearance of grooves along the length of the nails. These ridges may be deep or shallow and subtle.

In longitudinal ridging, raised vertical lines appear on the nails. These ridges may be deep or shallow and subtle. (Adobe Stock Images)

Yellow Nail Syndrome

As its name suggests, yellow nail syndrome occurs 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.

Yellow nail syndrome is a rare condition. The nails gradually turn yellow and thicken. (DermNet NZ)

Splintering Hemorrhages

Splintering hemorrhages are dark streaks or lines resembling bruises underneath the nails. These hemorrhages are caused by damaged or leaking capillaries (tiny blood vessels). Although RA can cause splinter hemorrhages, they are not the sole cause. Other causes include nail trauma (like stubbing your toe), endocarditis, fungus, or other health conditions, like vasculitis or Raynaud’s disease.

A splintering hemorrhage is a longitudinal (runs lengthwise), red-brown hemorrhage under a nail that looks like a splinter. (DermNet NZ)

Onycholysis

You may experience onycholysis (nails lifting from their beds, leaving white marks underneath). This condition is more commonly associated with psoriatic arthritis, but it may still affect individuals with RA. Fungal infections, reactions to certain medications, and thyroid disease are other causes.

In onycholysis, the nail separates from the skin underneath it. (DermNet NZ)

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.

If your lungs are affected, your nails may experience clubbing from RA. Clubbing happens when your nails start curving downward as they grow. (DermNet NZ)

Telangiectasia

Telangiectasia, also known as spider veins, occurs when blood vessels in the nail beds dilate (widen). This causes them to become more visible near the surface of your skin. Telangiectasia may be associated with RA, as well as other autoimmune diseases, such as scleroderma and dermatomyositis.

Telangiectasia occurs when blood vessels in the nail beds widen. (DermNet NZ)

Managing Nail Changes With RA

Talk to your rheumatologist about changes to your nails. Nail symptoms often do not require specialized treatment. Below are some options for managing nail symptoms.

At-Home Remedies

Members of myRAteam have recommended their own at-home remedies for various nail changes. One individual wrote that, after visiting her doctor, she was prescribed prenatal vitamins to deal with longitudinal ridges.

Another 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.

Basic Nail Care

Although topical treatments alone cannot resolve nail ridging or other nail symptoms, taking proper care of your nails can help alleviate symptoms. Applying moisturizer, limiting or avoiding nail exposure to harsh chemicals, and maintaining proper nail hygiene through regular trimming and cleaning can all help improve the appearance of longitudinal ridging.

Covering Nail Changes

If you feel insecure about deep ridging or severe discoloration on your nails, you may find that covering these changes with nail polish or gentle buffing helps alleviate some of this distress. Avoid harsher treatments like gels or acrylics, however, as these can increase the risk of nail separation and cause further damage. Discuss any planned nail treatments with your rheumatologist, as they will be able to advise you on whether certain treatments may negatively affect your nail health.

Biotin is a vitamin that plays a role in nail strength, growth, and overall health. Many over-the-counter supplements contain 5,000 to 10,000 micrograms to be taken daily. Protein lacquers that provide extra strength to the nail can also be purchased without a prescription. There are prescription nail treatments that may help the nail appear more normal but do not treat the underlying condition.

Find Your Team

On myRAteam, the social network for people with rheumatoid arthritis, more than 191,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you experienced 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 myRAteam.

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Megan Cawley is a writer at MyHealthTeam. She has written previously on health news and topics, including new preventative treatment programs. Learn more about her here.

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