6 Ways Ankylosing Spondylitis Can Affect the Nails | MySpondylitisTeam

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6 Ways Ankylosing Spondylitis Can Affect the Nails

Medically reviewed by Florentina Negoi, M.D.
Written by Torrey Kim
Updated on January 2, 2024
Part of the nr-axSpA Doctor Visit Checklist series

Living with ankylosing spondylitis usually involves managing inflammatory back pain and joint pain. However, for some people, ankylosing spondylitis (also referred to as radiographic axial spondyloarthritis) can also lead to less common symptoms like headaches, jaw pain, and changes in their fingernails and toenails.

“I love having long, beautiful nails and always enjoyed having my nails done every two weeks,” one MySpondylitisTeam member wrote. “But since my diagnosis, my nails are in really bad shape. Does ankylosing spondylitis affect nail condition?”

Although nail changes aren’t among the most common symptoms of ankylosing spondylitis, about 10 percent of people with ankylosing spondylitis also have psoriasis, which causes nail symptoms in up to 79 percent of people. It’s important to talk to your rheumatologist about all your symptoms to make sure your health conditions are properly diagnosed and treated.

Check out six ways ankylosing spondylitis can affect your nails and what you can do about these symptoms.

1. Ridges

Ridges in the nail may be visible going vertically (up and down). This symptom causes the appearance of grooves, which may be deep and dark or shallow and subtle.

Inflammatory conditions, including eczema and psoriasis, can cause nail ridges. (CC BY-NC-ND 3.0 NZ/DermNet)

Some people may instead notice ridges running horizontally (side to side) on their nails. This is particularly common among people who have psoriatic arthritis. “My nails have awful ridges in them,” one MySpondylitisTeam member wrote.

No matter which direction the ridges travel, they’re worth mentioning to your rheumatologist.

2. Discoloration and Thickening

Thick, discolored nails are common in psoriatic arthritis, one form of spondylitis. (CC BY-NC-ND 3.0 NZ/DermNet)

In some cases, your nails might change color or get thicker, particularly if you’re affected by both ankylosing spondylitis and psoriasis. The color can range from yellow and light brown to white, depending on the cause.

Because having both spondylitis and psoriasis can increase the likelihood of developing discolored nails, be sure to report this symptom to your health care provider right away. You may be living with psoriasis — as well as ankylosing spondylitis — and not realize it until you notice nail changes.

3. Splitting or Peeling

Your nails may become more delicate and start to split, peel, or even crumble. As one MySpondylitisTeam member described their nails: “They split and break very easily.”

Some MySpondylitisTeam members report that their nails split or peel easily. (CC BY-NC-ND 3.0 NZ/DermNet)

Minor splits, chips, or breaks in the nails may not be cause for concern, but if your nails are separating from the skin and causing swelling or chronic pain, call your health care provider right away.

4. Pitting

Some people with ankylosing spondylitis may find that their nails have small depressions, known as pitting. These tiny pits can be shallow or deep, and you may not see them but can feel them if you run your finger over your nails.

Tiny depressions or indentations on the surface of nails are referred to as pitting. (CC BY-NC-ND 3.0 NZ/DermNet)

Pitting isn’t as common among people with ankylosing spondylitis as it is with other types of spondyloarthritis, such as psoriatic arthritis. However, in rare cases, nail psoriasis can be found in people with ankylosing spondylitis. Pitting is caused by irritation or inflammation in the nail matrix, which is the point where your nails begin to grow from your skin.

5. Slower Growth

You may find that your nails grow more slowly when you’re living with ankylosing spondylitis. This can result from the use of certain disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. Although this condition is likely to resolve over time, it can be frustrating, especially if you’re trying to grow out a broken, split, or discolored nail.

This symptom may not be serious enough to prompt your doctor to change your ankylosing spondylitis treatment, but it’s still a good idea to mention it when you meet with your rheumatology provider.

6. Onycholysis

Some people with ankylosing spondylitis experience onycholysis (nails lifting from their nail beds, leaving white marks underneath). This condition is more commonly associated with psoriatic arthritis and psoriasis, but it may also affect individuals with ankylosing spondylitis. Other causes include fungal infections, thyroid disease, and reactions to certain medications.

Onycholysis — the lifting of nails from their nail beds — is usually painless. Some drugs that treat spondylitis can cause this side effect. (CC BY-NC-ND 3.0 NZ/DermNet)

For instance, nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used to treat spondylitis, may cause onycholysis as a side effect.

Managing Nail Changes

Protection and prevention are key when you have nail problems. You’re more likely to see faster improvement when your ankylosing spondylitis treatment is coupled with a nail care plan to make sure your nails stay healthy.

To protect your nails, try these tips from the American Academy of Dermatology:

  • Trim your nails short to help keep them from lifting off your fingers and toes and avoid buildup under the nails.
  • If you have trouble reaching your toenails due to spine changes, consider purchasing a pair of long-handled nail clippers or going to a nail salon for nail care.
  • Keep your nails dry and clean to help prevent nail infections.
  • Wear gloves while washing dishes or gardening to avoid irritating your skin or nails, which may cause flares.
  • Don’t cut or push back your cuticles. Injured cuticles can lead to infection.
  • Skip artificial nails at your next manicure. Artificial nails can increase the risk of your nails separating from your fingers. Instead, opt for nail polish and gentle buffing.

Biotin

Biotin is a vitamin that plays a role in nail strength, growth, and overall health. If your doctor believes you have a biotin deficiency, they may suggest you take biotin supplements.

However, biotin deficiency is rare, so don’t take these supplements without first talking to your rheumatology provider. Getting too much biotin can lead to health risks and improper results on blood tests, and this supplement may interfere with your spondylitis treatment plan.

Vitamin D

Low levels of vitamin D are often seen in adults, and studies show that people diagnosed with ankylosing spondylitis have lower levels of vitamin D. A lack of vitamin D usually involves the bones but can also lead to nail changes. Your health care provider can determine if you need vitamin D supplements and recommend a proper dose.

Tell Your Rheumatologist About All Symptoms

Researchers haven’t determined just how often nail changes occur with ankylosing spondylitis. However, if you develop this symptom, it’s important to know that you have plenty of options to help strengthen your nails and improve your quality of life.

Your first step should be talking to your rheumatology provider. They may suggest treatment options or refer you to a dermatologist or podiatrist. It may take time to find the combination of therapies and lifestyle changes that works for you, but by working with your health care team, you’ll be able to come up with a treatment strategy that minimizes symptoms and side effects like nail changes.

One member of MySpondylitisTeam who needs strong fingernails to play the harp shared their experiences. “I’ve tried many approaches over the years — urea cream, nail strengthening lacquer, superglue with tissue, metal finger picks, and more. I pretty much gave up playing for a while. With the new biologic I’m taking, my fingernails are still ridged, but splitting/crumbling is less severe, and I can play more regularly.”

Get Support From People Who Understand

On MySpondylitisTeam, more than 95,000 members come together in a support group atmosphere to ask questions, give advice, and share their stories with others who understand life with ankylosing spondylitis.

Have you noticed nail changes while living with ankylosing spondylitis? What strategies have helped you manage them? Comment below, or start a new conversation on your Activities page.

Updated on January 2, 2024
All updates must be accompanied by text or a picture.

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Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here.
Torrey Kim is a freelance writer with MyHealthTeam. Learn more about her here.

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