FINGER NAIL Psoriatic Arthritus

[pkidd]

For the past 15 years I've experienced a mild case of PA that affects my fingernails and toenails only. I get very mild swelling in a few distal joints on 2-3 fingers (no joint problems on the toes) and some nail problems caused by the rash like dots that form under the nails, causing the nails to seperate from the nail bed in the affected area only.
My doctor informed me of Methotrexate and suggested I take 7.5mg per week. I'am an identical twin, my twin brother does not have this problem and I wonder if it is something else. They already ruled out Fungus. Any comments on the methotrexate and this condition is appreciated.

[CJ]

Hi pkidd,

Humm I dont know about MTX for that I am Taking it for my PA do you have PA or just P? I have had the uneven bonding of the nail bed but my nails have not fallen out. I have heard of a process where they inject Steroids under the nail into the nail bed or around the nail bed right behind the nail. That is one option its prob painfull and would have to be repeated. But If I just had my nails involved I might consider that instead of the MTX. The MTX might or might not help and that is something you and your specialist should decide. I am taking .60 Mtx and will be getting an increase. I do not like the idea of taking the MTX but its better than having my body covered in patches and my chest and lower and upper spine hurting as much. I wish you the best of luck. I hope I was able to shed some light on my perspective of taking MTX. Oh there is a new form of MTX called TREXALL that is suppose to have less side effects I have seen some poastings on the board about it. Look into that it might be better and at least less side effects.

Peace and positive thoughts

C.J.

[fitzy]

I have had bad nails for years. Keep them trimmed short and file under the nail to remove scaling will help some. Don't give fungus a place to start!

[Lorna]

Hi,
Why not try something simple first? It seems Methotrexate would be kind of extreme if you only have nail involvement. Summers Labs has a product called Dermanail that you might try. It is over the counter. Or you could try soaking your nails in a combination of warm apple cider vinegar mixed with regular table salt for 5 to 10 minutes. This cleared my nails.

[Dave L]

Another simple idea is to try a sunlamp on your nails.

[kmfitzpatrick1]

I am taking the methotrexate and am up to 25 mg a week. I have had no side effects during this time (2 months) and the nails appear to be growing out somewhat. However, the arthritis is extremely painful in the joints below each effected nail and that is not improving. I also have pustule skin problems on my heels. I have tried so many meds, creams, gels, etc. over the last three years and nothing helps the outbreak for long. I read about the cider vinegar trick in the NPF Bulletin and just started that two days ago. The red swelling of the joints is so painful that I need vicodin to type on this keyboard. The pain is like electric shock or millions of little needles in the red swollen areas. Does anyone else have any suggestions?

[FrankLee]

Are you a smoker?
I feel there may be a connection with 'oxidisation' here.
I got nail problems after using dovonex long-term.
To support your nail growth you can take one small square of jello perday for the gelatine. In the UK(where I'm at) the best brand is Rowntrees. Don't take the sugar-free or powdered versions.
Things like vitamin C and cod-liver/olive oil and drinkng fresh pure water, eating fresh fruit can also help. Things like sweet peppers have more vitC than oranges so this could help to.
Doing exercise can also help to keep the blood pumping to the fingers.

I'm not sure about the UV suggestion as I think I saw somewhere that UV damage can also affect the nail beds, though I'm not 100% sure about that.

Hope this helps,

All the best, FrankLee :)

[RacerX]

Chances are the UV route would not work since the nail growth starts back behind the cuticle.

[RichJ]

hi pkid and davel,
sorry i can't help much but welcome to the pfamily. you will meet alot of wonderful poeple on here and will find alot of great info. welcome and nice to meet you

have a good night all

richard

[Joann71]

Are you a smoker?
I feel there may be a connection with 'oxidisation' here.
I got nail problems after using dovonex long-term.
To support your nail growth you can take one small square of jello perday for the gelatine. In the UK(where I'm at) the best brand is Rowntrees. Don't take the sugar-free or powdered versions.
Things like vitamin C and cod-liver/olive oil and drinkng fresh pure water, eating fresh fruit can also help. Things like sweet peppers have more vitC than oranges so this could help to.
Doing exercise can also help to keep the blood pumping to the fingers.

I'm not sure about the UV suggestion as I think I saw somewhere that UV damage can also affect the nail beds, though I'm not 100% sure about that.

Hope this helps,

All the best, FrankLee :)

I am not a smoker, in fact I don't even like to be around people smoking and my nail psoriasis is pretty painful.

[docmks]

Hi JoAnn

I am so sorry you are suffering so. I know how badly that fingertips and nail beds can hurt from PA and P. I have used a strong steroid topical, Clobetosol, and also Protopic (which has a warning for the potential for unpleasant side effects) on my fingers. I also did find that went I went on MTX that my skin got better. I used to have bad finger psoriasis at time that affected finger tips and nails and then my whole digit would swell. Even so there is no evidence of joint damage. I also have used a biologic. Currently, I am on Humira.

I wanted to comment that your twin not having P or PA is probably not unusual. There are several different genes involved in P and PA (they are what we call polygenic traits). Stature and weight are polygenic traits, as is skin pigmentation/eye color. Polygenic traits always are influenced by environmental factors as well as genes. So, there is possibly something that triggered the genes in you, as opposed to your twin. Did you have problems with strep infections that your twin managed to escape? Infections of some types are pretty notoriously involved with triggering P and PA. There may be other triggers as well that you've experienced that your twin hasn't...this may account for the difference.

I found that MTX made me tired and gave me problems with my stomach, but when I'm on it, it does make a big difference in my skin (not so much in my bones and joints).

I hope you feel better really soon,
MK

[JDCF]

This drives me nuts!

My dermatologist told me that the only thing that would help my nails is enbrel. I have taken 4 weeks worth of shots. I assume and hope that after the nails that are now pitted, scored, indented, etc grow out or fall out, I will again have normal nails.

I truly do not know what to think or believe. How our P and PA manifest in each of us is different AND what our physicians tell us is also different.

Do they really know?

John

[AnnieB]

As far as the nails go, my dermotologist suggested using Taclonex twice a day, making sure to massage it into the nail bed (the skin at the base of the nail) for at least five minutes after application. This cleared up the nail problem. But I don't think it helps with the psoriatic arthritis. Still, cosmetically, it was great! (I thought I should put it under the nail at the top and she explained that it is important to get it into the nail bed because that is where the new growth is. It takes a while to see improvement, as your nails have to grow out.)

[amberck]

This drives me nuts!

My dermatologist told me that the only thing that would help my nails is enbrel. I have taken 4 weeks worth of shots. I assume and hope that after the nails that are now pitted, scored, indented, etc grow out or fall out, I will again have normal nails.

I truly do not know what to think or believe. How our P and PA manifest in each of us is different AND what our physicians tell us is also different.

Do they really know?

John

My nails were the same way and they grew in normal after about 2-3 months on Enbrel. =)

[Noxide]

For the past 15 years I've experienced a mild case of PA that affects my fingernails and toenails only. I get very mild swelling in a few distal joints on 2-3 fingers (no joint problems on the toes) and some nail problems caused by the rash like dots that form under the nails, causing the nails to seperate from the nail bed in the affected area only.
My doctor informed me of Methotrexate and suggested I take 7.5mg per week. I'am an identical twin, my twin brother does not have this problem and I wonder if it is something else. They already ruled out Fungus. Any comments on the methotrexate and this condition is appreciated.

I've used 400ui per day of vit e and it cleared my nail p. Please keep in mind it takes about two months for it to start working but it did work for me. Use a brand name. Good Luck!

[4Given]

My PA started exactly the same way. The pitted nails, the little red/ brown blisters under the nails. The blisters started spreading down the index fingers on both hands. Then the fingernails started detaching by lifting up from the tip backwards. That it when it became extremely painful.

I went to four different dermatologists and then the esteemed Mayo Clinic. I received five different diagnosis. Fungus, Excema, Dyshydrotic Excema, conatct dermatitis, and the Mayo bombshell ~ warts growing under the fingernail! Yep i asked them OK I could buy that one one fingernail by not on the same digits on both hands. I had biopsies taken from under the nail and from my finger. Each time I would ask could this be psoriasis? No, Nope it is not psoriaisis. Oh yes and one derm put me on the liver killer Lamasil for a whole round of treatment, with very little results. So there may have been some fungus amungus but 99% of it was not.

But everything I was reading off the internet led me to believe otherwise. I made an appointment with a rheumatologist. Who examined my whole body, listened to my story, took blood work xrayed my hands, my feet, and my R elbow, which had started to hurt. Oh yes and I had conjuctivitis in my left eye.

Every time I went to the derms I had most of the same sysmptoms. The rheumy says yes you have got PA and now lets start treating it now befor the joint damage gets worse I had some limited damage.

He put me on the Methotrexate, which I was not thrilled with either after reading my wifes PDR, she is a nurse. Within three weeks the nails started improving and the blisters started leaving my fingers. The pain started to go away.

After four months my nails were normal again. I had suffered immensely with my index fingers for over a year and the my middle fingers on each hand had started the same thing and it was slowly starting to show up on the next fingers as well.

Due to the fact I hate taking medication. After a year when it was all healed up I decided to quit taking the MTX to see if I had acheived a remission, within three weeks the blisters started returning under the index fingernails. I went back on the MTX and once again they went away. So I can say MTX is working for me.