Nail changes and rheumatoid arthritis: All you need to know

RA is an autoimmune condition. This means that symptoms happen when your immune system is overactive and mistakenly attacks your body’s cells.

Based on data from 2007, 1.5 million people in the United States have received a diagnosis of RA.

In RA, your immune system attacks the lining of your joints, which doctors refer to as the synovium. The effects of this inflammation can cause pain and affect your:

• organs
• energy levels
• joints
• nails

Nail changes can be a sign of early stage RA. Nail symptoms can happen before you notice any typical symptoms such as joint pain.

Understanding what nail changes to look out for can help you receive a diagnosis of RA sooner or let you know whether you should seek medical help for another condition.  

How does it affect the nails?

RA results in your immune system attacking healthy cells in your body. Sometimes, this takes the form of changes to your nails.

Nail changes caused by RA are not typically harmful, unlike those caused by psoriatic arthritis. They are also not the most common symptoms of RA, according to a 2021 research review.

But certain changes can happen. Nail changes include the development of vertical ridges or the yellowing and thickening of the nail bed.

Sometimes these changes may result from the treatment you receive to manage your condition or another underlying health condition.

Researchers are still uncertain what the exact reasons for these changes are, but it likely has to do with changes to your blood vessels and vascular system under the nail fold, which is common in people with RA.

Possible changes

Nail changes due to RA are not typically painful and should not require any specific treatment. A study from 2023 reports that longitudinal nail ridging is present in 58–73% of people with RA.

Longitudinal nail ridges

Longitudinal nail ridging, also known as onychorrhexis, looks like vertical lines that run vertically (longitudinally) from the top of your nail to the nail bed at the bottom. These lines can be faint or deep grooves in the nail.

Researchers find that certain medications for RA can cause longitudinal nail ridging. These include:

• methotrexate
• corticosteroids
• leflunomide

Biologic medications do not cause nail ridging in people with RA.

Yellow nail syndrome

Yellow nail syndrome, as the name suggests, causes your nails to yellow and thicken. This thickening can cause the sides of your nails to curve.

This condition can occur with RA. According to the National Organization for Rare Disorders, certain RA medications can also cause yellow nail syndrome.

Yellow nail syndrome can be a sign of many different health conditions. It is important to have a healthcare professional check out these symptoms if you notice them.

If you suspect your RA medication is causing yellow nail syndrome, you can talk with a doctor about which medications or treatment options may work best for your specific needs.

Splinter hemorrhages

These are vertical lines that develop from blood vessel damage or inflammation of the blood vessels underneath your nail. They can appear as a small brown, black, or purple line or a large dot. They are not typically painful.

Splinter hemorrhages mostly result from injury to the nail, but can also be a sign of an underlying health condition, such as RA.

Other symptoms of RA

Changes to your nails can be a symptom of RA, but you are more likely to notice other symptoms first. These are typically more severe than nail changes. It is helpful to talk with a doctor about receiving a diagnosis and treatment to keep them from progressing.

These other symptoms can include:

• shortness of breath
• swollen and stiff joints all over your body
• fatigue
• formation of bony growths on your finger joints
• dry eyes
• inflammation of the heart, or pericarditis

Treating rheumatoid arthritis

By working with a healthcare professional, you can create a treatment plan that uses a combination of treatments to help manage your symptoms.

If you do not receive treatment, RA can progress and cause difficulty in your daily functioning. The main goals of RA treatment are to:

• help you manage your symptoms
• prevent further damage to your joints
• improve your quality of life

Some medications that a healthcare professional may recommend to treat RA include:

————-

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.

Some lifestyle changes can help manage symptoms of RA. Some of these include:

• exercise
• rest
• eating a nutritious anti-inflammatory diet

Summary

If you spot changes in your nails, it could be a sign of RA. Yet many different health conditions can change the appearance of nails. It is important to seek advice from a healthcare professional if you notice these symptoms.

RA is a chronic autoimmune health condition that can cause pain and stiffness in your joints. It requires medical treatment to manage your symptoms and make daily functioning easier. Nail changes can be an early sign of RA.

—————

Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.