Psoriatic arthritis is best known for the damage it can do to your joints, but changes to your nails — both fingernails and toenails — can also signal that something is amiss inside your body.

Nail problems are a predictor of psoriatic arthritis as well as a common symptom, according to Francis C. Luk, MD, a rheumatologist at Advent Health in Hendersonville, North Carolina. He describes a condition called pitting: “It can look as though someone took a sharp pin and just punctured the nails multiple times. That’s a sign that psoriatic arthritis is going to develop, if it hasn’t already,” he says.

Research suggests that approximately 80 percent of people with psoriatic arthritis experience some nail damage. The effect of psoriatic arthritis and psoriasis on nails and nail beds is an often overlooked but potentially disfiguring complication.

“Nail involvement in psoriatic arthritis can range from very mild nail pitting all the way to severe dystrophic nail changes” that include extreme alterations in color and shape, says Neha Shah, MD, a rheumatologist and clinical assistant professor in the department of immunology and rheumatology at Stanford Health Care in Palo Alto, California.

Doctors have a number of treatments for nail problems caused by psoriatic disease, which they may utilize individually or in combination.

According to the American Academy of Dermatology (AAD), options may include:

• Topical Medications Placed directly on the nails, these drugs, which include corticosteroids, are designed to slow cell growth; You usually apply topical treatments overnight, sometimes placing plastic wrap over the medicated areas to make the drug more effective.
• Injected Corticosteroids Doctors inject steroids directly into the affected nail matrix, where the nail forms. Injections are given every four to six weeks.
• Laser Therapy This can sometimes be effective. A study found that treatment with a fractional CO2 laser followed by a topical application of methotrexate or topical corticosteroid compound is an effective treatment for nail psoriasis.
• Systemic Medications Psoriatic arthritis treatments that work throughout the body may be appropriate for people with more severe disease and nail issues. Common systemic medications for psoriatic arthritis include biologics, methotrexate, cyclosporine, and apremilast.

Doctors may need to try different treatment strategies, and possibly more than one at the same time. The National Psoriasis Foundation suggests setting realistic goals; because nails grow slowly, it may take 6 to 12 months to see improvement.

“Besides working with a rheumatologist to treat the underlying psoriatic arthritis, which is the best way to treat nail involvement, patients should follow common sense nail care to help prevent trauma to the nail bed that could trigger more inflammation,” says Dr. Shah.

Nails affected by psoriatic arthritis can break easily, and trauma can exacerbate or trigger a flare-up of symptoms. Taking steps to protect your nails is key. The AAD offers a few tips that can help:

• Keep nails short. Trim nails, or file down thick toenails with an emery board. Whether or not you have psoriatic arthritis, file toenails straight across to prevent them from becoming ingrown.
• Avoid artificial nails. Nail polish is fine, but artificial nails can increase the chance of your nails separating from the nail bed, which can be a common issue with psoriasis.
• Wear gloves when doing manual labor or using soaps or chemicals. Gloves can protect nails from getting injured or irritated.
• Don’t bite or pick at your nails or the skin around your nails. This can harm your nails and increase the possibility of infection.

Additional research by Becky Upham.