Symptoms of Psoriatic Arthritis in the Hands and Feet

Written by Samantha C. Shapiro, MD | Reviewed by Mandy Armitage, MD Published on March 10, 2022 print_outlinedemail_outlined

Key takeaways:

• Psoriatic arthritis (PsA) is an autoimmune condition that causes inflammation in the skin, nails, joints, and tendons. This is especially true for the hands and feet.
• Symptoms in the hands and feet include joint pain and stiffness, as well as swollen fingers and toes. Nail changes due to psoriasis may also occur.
• Treatment options for these symptoms are the same as those for other PsA symptoms: anti-inflammatory medications and immunosuppressants.

Psoriatic arthritis (PsA) is an inflammatory arthritis that can affect any joint in the body; but, for reasons that are unclear, it really likes the hands and feet. Inflammation in the skin and nails is also common. The good news? Thanks to modern medicine, PsA is a very treatable condition!

In this article, we review what PsA can do to the hands and feet and how to treat it.

What are the first symptoms of psoriatic arthritis?

PsA is different for every person who has it, so the first symptoms are different for everyone, too. Joint pain and stiffness are common and can affect any joint in the body, including those in the hands and feet. PsA can also cause inflammation of the tendons and entire fingers or toes (dactylitis, or “sausage digits”).  

About 25% of people who have psoriasis also have PsA. Psoriasis rashes typically appear before joint pain, but sometimes rashes can show up later or at the same time. Interestingly, it’s also possible to have PsA without psoriasis, but this is rare. 

What are the symptoms of psoriatic arthritis in the hands?

When PsA affects the hands, any joint can be involved. It’s common for inflammation to be asymmetric, affecting some joints in one hand and different joints in the other.

 Hand joints commonly affected by PsA include:

• Carpal joints (wrists)
• Metacarpophalangeal joints (knuckles)
• Proximal interphalangeal joints (joints in the middle of the fingers)
• Distal interphalangeal joints (joints closest to the fingernails) 

Because rheumatoid arthritis (RA) also affects joints in the hands, it’s sometimes difficult to distinguish between the conditions. But RA leaves the distal interphalangeal joints alone. So inflammation there is a clue that you are dealing with PsA, not RA.

Another symptom that can help distinguish PsA from RA is dactylitis — inflammation of all of the joints and tendons in one finger.

Symptoms of dactylitis include:

• Pain and tenderness of the entire finger
• Swelling of the entire finger (like a sausage)

• Warmth
• Redness
• Difficulty bending the finger due to swelling and tightness

What are the symptoms of psoriatic arthritis in the feet?

When PsA affects the feet, any area can be involved — including the 26 bones, 33 joints, and many more muscles, ligaments, and tendons in your foot! 

Common symptoms of PsA in the feet include:

• Arthritis: painful, swollen toe and ankle joints. This is often asymmetric, just like in the hands.
• Dactylitis: sausage-like swelling of a toe. The symptoms are the same as those listed above for dactylitis of the fingers.
• Tendonitis: inflammation of the tendons, the tissues that attach muscles to bones. For example, the Achilles tendon is commonly affected.

• Heel pain (enthesitis): inflammation in the area where the tendon attaches to the bone (for example, the back of the heel, just above where it hits the ground).
• Pain on the sole of the foot: inflammation of the fascia, the layer of tissue that covers the bottom of your foot. 

What does PsA in the hands and feet feel like?

PsA hand pain feels different for everyone. Some people describe a deep ache, a throbbing, or a sharp pain. Others feel like the pain jumps from place to place. Symptoms can come and go, so some days you feel okay and some days not as much. 

PsA foot pain depends on what part of the foot is inflamed. Arthritis in the toe joints might feel like walking on pebbles. Inflammation in the bottom of the foot can cause pain that’s worse when your feet first touch the floor in the morning or when you’re walking.

Stiffness in the hands and feet is also common with PsA. It typically takes at least 30 minutes for hands and feet to loosen up, but, for some, it can take the whole day.  

What are symptoms of psoriatic arthritis in the nails?

Sometimes, psoriasis can cause more than just rashes. It can also affect the fingernails and toenails. Signs of nail psoriasis include:

• Tiny dents (nail pitting)
• Spots that look like drops of oil
• Separation or lifting up of the nail from the finger or toe (onycholysis)
• Crumbling
• Buildup underneath the nails
• Thin lines of dark blood underneath the nails
• Color changes (white, yellow, or brown discoloration)

Nail psoriasis, while treatable, can be a bit stubborn because nails grow so slowly. It can take 6 months or longer for nails to grow back normally. 

How do you treat psoriatic arthritis symptoms in the hands and feet?

Treatment of PsA symptoms in the hands and feet is the same as treatment for PsA in general. Medications called immunosuppressants treat the cause of inflammation in the hands and feet: an overactive immune system that is attacking the skin, joints, and tendons. 

The goal is to find a medication regimen that clears your skin and improves joint pain and swelling, everywhere you’re affected. (There is no treatment that specifically targets the hands and feet.) It can take some time to find the medication or medications that work for you, but there is a regimen out there that can do both!

During a PsA flare (temporary worsening of symptoms), anti-inflammatory medications like steroids or non-steroidal anti-inflammatory drugs (NSAIDs) can quiet down symptoms in a short amount of time. A quick course of anti-inflammatories may be particularly helpful for dactylitis and enthesitis. 

While it’s rare, steroid injections near tendons and joints may be performed, too. Steroid shots are typically a last resort since there are potential side effects. 

Left untreated, PsA can cause complications, including permanent joint damage. This can cause deformities (visible changes) in the hands and feet and difficulty performing daily activities. So starting treatment early is important. It might feel overwhelming, but talk to your provider about treatment options. You can work together to find a regimen that you feel comfortable with. 

The bottom line

PsA is a highly treatable condition, which means that life without pain in your hands and feet is a realistic goal. Living with PsA can be challenging. But with a little time and help from medications, you can be back on your feet in no time — literally.