Cutting a lifted toe nail - yes or no?!

[Cowsaregreat]

I have psoriasis under 2 finger nails. Luckily for me 1 has cleared up (mostly) but my thumb nail is tough as old boots and I keep it short so I don’t catch it. I now have psoriasis under one toe nail. It’s lifting off and I’m unsure whether to cut it right down as far as possible as it sometimes catches on my sock. It’s only lifting on the left side but it’s nearly down to the bottom and I’m concerned it’ll get ripped off and that’ll hurt! Can anyone advise please.

[Caroline]

Hi Cowsaregreat,

I think that you would regularly have to file it smooth, and keep it schort indeed.
You can go to a  pedicure, she might have advice on how to treat it, but be aware to mention that you have psoriasis.


Some warning..
Do you already have Psoriatic Arthritis ?
As problems with the nails often indicate an approaching Psoriatic Arthritis.
If so, be aware that if that happens, that must be treated asap.
A Rheumatologist probably would start with mtx, which will not work, and also you already had that and your liver did not react well.

So negotiate if necessary with a Rheum .

Other signs of PsA may be hurting tendons.

[Cowsaregreat]

Thank you for your reply. When I next see my Dermatologist I will mention it as I’ve noticed just recently I get so achy. Everything hurts. I know that could be for a variety of reasons - menopause, the exercise I do and  simply just getting older etc. I’m slightly paranoid about getting pa. No idea why as nothing I can do about it! Think my concern is that it’ll go undiagnosed but I do love to have something to occupy and worry my head with!

[Fred]

I agree with Caroline keep it short and rub it down with emery board, and also yes it's a classic sign of psoriatic arthritis.

If you can try to see your dermatologist a bit quicker if possible, but if it is psoriatic arthritis your current treatment isn't going to help. Sorry to be the bearer of possibly bad news, but psoriatic arthritis can be managed and the important thing is to get it sorted as early as possible.

I'm a classic example of psoriatic arthritis, I got it, ignored it, almost ended up in a wheelchair, took advice, now I'm old and getting my life back. So don't be afraid to get your dermatologist to check it out (actually insist that they do) if you get on the first rung of the ladder early the better it will be later on.

Don't worry we are here and some of us are doing fine with psoriatic arthritis, do report back as your information may help others in the future.

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[Forest Walker]

How will a Rhumatologist diagnose PsA?

Cowsaregreat, I have two toenails affected and do my best to trim, but it's difficult.  I use a glass nail file to smooth them down as much as I can because they do sort of tear up the sheets and snag the socks.  Good luck to you.

[Caroline]

Well in fact the diagnoses of PsA is very difficult. There is nothing in the blood that will point to PsA.
So the possibilities are:

• Being at least a very good rheumatologist.
  
• Having joint pains, often first in fingers and feet
  
• Having swollen joints
  
• Having enthesitis, inflammation of tendons near the attachment to the bones
  
• Doing a pet scan or MRI of the relevant joint. 
  
• Excluding rheuma by checking the blood on rheum factors (no rheum does that to my knowledge)
  
• Checking if patient has psoriasis, as it is often a comorbidity of psoriasis. 
   
  

I think that is about it.
There is more but rheumatologists do not know that and that is that if you extract the fluid from the swollen joint and you check that under a microscope, they you will see pyruvate chrystals. That in fact is an absolute verdict that you have it. (This knowledge comes from a internist doctor with years of psoriasis experience)

[Fred]

How will a Rhumatologist diagnose PsA?

Without going too off topic a rheumatologist doesn't have a clue when it comes down to psoriatic arthritis, a good dermatologist knows the signs.

But that is my opinion from my own experience.

[Kat]

Don't know if it would help but I have thicker nails than I used to so I bought an electric manicure file (a nail grinder.) It has different attachments and I find it's been much easier to use than a regular file or emery board. It keeps things smooth for me but I don't have lifted nails so that's why I'm not sure if it would help or not.

[D Foster]

I was lucky as the Dermatologist and the Rheumatologist work together in the Spire Health Care. I have some problems with the PsA but the Stelara still works well for me on both areas .