Psoriatic Arthritis (PsA) is an inflammatory arthritis commonly associated with psoriasis and can have profound effects on the feet and nails. It often presents with a combination of enthesitis (inflammation where tendons or ligaments attach to bone), joint damage, and notable changes in the nails.
🔎 Real-World Case Example
Below are two clinical photos of one of my clients living with PsA. She experienced:
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Onycholysis: Detachment of the nail with a granulated, tender nail bed. Granulated nail bed is a condition found commonly in PsA
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Osteolysis: Advanced bone breakdown and reabsorption, leaving her toes feeling soft and bendable due to complete joint deterioration
The joint damage from osteolysis was so severe that her toes had almost no resistance — bending in all directions like they were made of rubber.
🧠 PsA vs. RA: What Makes It Different?
While Rheumatoid Arthritis (RA) is primarily characterized by synovitis (inflammation of the joint lining), PsA is defined by enthesitis and may include:
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Joint erosion or osteolysis, particularly at smaller joints
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Nail changes such as pitting, discoloration, onycholysis, and thickening
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Asymmetrical joint involvement
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Dactylitis (a.k.a. "sausage toes or fingers")
🩺 Foot Care Nursing Considerations
Clients with PsA are typically diagnosed and treated by a rheumatologist, often using immunosuppressants such as methotrexate or biologics.
However, foot care nurses play a crucial supportive role in:
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Monitoring for skin and nail changes
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Managing pressure points and deformities with offloading or footwear support
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Reporting worsening symptoms or joint function changes
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Providing gentle nail care to avoid triggering inflammation
⚠️ Comorbidities & Lifestyle Counseling
Clients with PsA are at increased risk for:
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Cardiovascular disease (CAD)
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Diabetes mellitus (DM)
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Depression and anxiety
These overlapping conditions increase morbidity, so we must remain aware of whole-person health when providing care.
✅ Lifestyle factors matter:
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Avoid alcohol when taking methotrexate
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Encourage exercise to maintain musculoskeletal strength and reduce joint pain
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Promote a heart-healthy diet to lower CAD and DM risk
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Offer support or refer to resources for mental health and emotional wellbeing
Early recognition and collaborative care can make a lasting difference in the lives of clients with Psoriatic Arthritis.
📸 Client images shown with full permission for educational purposes.