Living with ankylosing spondylitis usually involves managing symptoms like back pain or joint pain. However, for some people, this condition can also lead to 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 — also referred to as radiographic axial spondyloarthritis — some people do experience nail issues. Check out six ways this condition can affect your nails and what you can do about it.

1. Ridges

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

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

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.

About 10 percent of people with ankylosing spondylitis also have psoriasis, and a 2019 review of research reported that 50 percent to 79 percent of people with psoriasis have nail symptoms. Therefore, nail psoriasis may sometimes affect people with ankylosing spondylitis.

Because having both conditions 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.”

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.

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, 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 AS 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.

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 Association:

• Trim your nails short to help keep them from lifting off your fingers and toes and avoid buildup under the nails.
• 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.
• Pass on 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 that 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.

Meet With Your Doctor

Researchers haven’t looked into 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 clear and strengthen your nails and improve your quality of life.

Your provider may suggest treatment options such as using a corticosteroid for a short period. It may take time to find the combination of therapies and lifestyle changes that works for you, but by working with your rheumatologist, you’ll be able to come up with a treatment strategy that minimizes side effects like nail changes.

Get Support From People Who Understand

On MySpondylitisTeam, more than 93,000 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.