Psoriatic Arthritis of the Hand

Patient education about psoriasis-related arthritis, hand symptoms, diagnosis, and treatment options.

Figure 1: Scaly, red, dry skin patches from psoriasis on wrist.
Figure 1: Scaly, red, dry skin patches from psoriasis on wrist.

Arthritis describes any condition where cartilage in the joint breaks down. Normally, a joint has two smooth, cartilage-covered bone surfaces that fit together and glide against one another. Arthritis can occur when these smooth surfaces become irregular and no longer fit well together.

Psoriatic arthritis is a condition in which the lining of the joint becomes inflamed and swollen. Because this inflammation stretches the tissues that keep the joint strong, the joint may become loose or crooked. The smooth ends of the bones can also wear out, and the bone may lose its normal shape.

Psoriatic arthritis can affect any joint in the body and affects men and women equally. Psoriasis is a skin condition that can cause dry, red, flaky skin. It can affect any part of the body. According to the source handout, up to 30% of people with psoriasis develop psoriatic arthritis.

Arthritis can be debilitating when it affects the hands and fingers. Common forms of arthritis in the hand include osteoarthritis, post-traumatic arthritis after injury, and rheumatoid arthritis. Other causes include infection, gout, and psoriasis.

Signs and Symptoms

Figure 2: Sausage finger with swelling of middle joint (PIP).
Figure 2: Sausage finger with swelling of middle joint (PIP).

The joint changes seen with psoriatic arthritis can be similar to those seen with rheumatoid arthritis. Symptoms can include:

  • Red and swollen joints
  • Joints that sometimes feel warm
  • Decreased joint motion and stiff-feeling joints

With psoriatic arthritis, the hands may not be affected equally. It may be difficult to tell psoriatic arthritis from other types of arthritis because many types of arthritis can cause stiffness, swelling, and pain.

In psoriatic arthritis, swelling often affects the whole finger, especially around the middle joint. Fingernails may show pitting, ridging, or crumbling. The joint at the end of the finger may become deformed. Other parts of the hand and wrist are not usually affected.

Diagnosis

Figure 3: Pencil-in-cup deformity of end joint of finger.
Figure 3: Pencil-in-cup deformity of end joint of finger.

Psoriatic arthritis may be suspected when a person has psoriasis and develops joint problems. A doctor will usually examine the hand, feel the joints, and review x-rays.

X-rays may show loss of the normal bone shape, mainly at the end joint. They may also show swelling around the bone, narrowing of the space between bones, or fusion of bones at a joint. There is no special blood test to diagnose this type of arthritis. In some cases, a small piece of skin may be removed to help determine whether a person has psoriasis.

Treatment

There is no cure for psoriatic arthritis, but medications may help lessen swelling, redness, and pain while helping the hands function as well as possible. Different medical specialists may work together in treatment, including physicians and therapists.

Surgery may help treat some problems related to psoriatic arthritis. The type of surgery depends on the specific pain and function problems. A hand surgeon can help guide treatment options based on a patient’s individual concerns.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.