Nail and Joint Issues: Causes, Symptoms, and Treatment Options

Nail

In recent years, I have experienced swelling and protrusion in several joints of my fingers.
The swollen areas sometimes feel hard and at other times soft.
The joint closest to the nails has become deformed and bent, especially noticeable since last year.
My left middle finger has frequent swelling and pain at the junction between the nail root and the joint.
When pressed, a clear, gelatinous fluid oozes out from the grooves and seams on the back of the finger.
The sides of the nail are also indented and grow unevenly, and the wounds are prone to infection.
This condition has persisted for almost a year.
I have seen an orthopedic doctor who mentioned it might be an immune system issue, but there is no solution provided.
What could be the cause of this, and how can it be treated? Please help me.

cynthia, 40~49 year old female. Ask Date: 2005/10/05

Dr. Lin Mingxing reply Family Medicine

Dear Cynthia,
As you mentioned, rheumatoid arthritis or osteoarthritis are both possibilities.
Additionally, the acute localized joint condition may be complicated by an infection.
Please seek evaluation from an orthopedic surgeon or a rheumatologist as soon as possible.
Wishing you good health and all the best from the Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare.

Reply Date: 2005/10/05

More Info

Based on your description, it sounds like you are experiencing significant issues with your finger joints, including swelling, deformity, and pain, particularly around the base of your left middle finger. The presence of a clear, gel-like fluid oozing from the joints, along with the deformation of the nails, suggests a potential underlying inflammatory or autoimmune condition.

Possible Causes
1. Rheumatoid Arthritis (RA): This is an autoimmune disorder that primarily affects the joints, leading to inflammation, swelling, and pain. It can cause deformities in the fingers and may also affect the nails, leading to changes in their shape and texture.

2. Psoriatic Arthritis: If you have a history of psoriasis (a skin condition), this could be a possibility. Psoriatic arthritis can cause joint pain and swelling, as well as changes in the nails, such as pitting or separation from the nail bed.

3. Gout: This is a type of inflammatory arthritis that occurs when uric acid builds up in the body, leading to sudden and severe pain, redness, and swelling in the joints. While gout typically affects the big toe, it can also affect other joints.

4. Infectious Arthritis: The presence of fluid that can be expressed from the joint may indicate an infection. Infectious arthritis can cause swelling, pain, and sometimes fever.

5. Other Autoimmune Conditions: Conditions like lupus or scleroderma can also affect the joints and nails, leading to similar symptoms.

Symptoms to Monitor
- Joint Swelling and Pain: Persistent swelling and pain in the joints, especially if it is symmetrical (affecting both hands).

- Nail Changes: Deformation, pitting, or separation of the nails from the nail bed.

- Fluid Discharge: The presence of clear or cloudy fluid from the joints, which may indicate inflammation or infection.

- Skin Changes: Any rashes or skin changes, particularly if you have a history of psoriasis.

Treatment Options
1. Medications: Depending on the diagnosis, treatment may include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To reduce pain and inflammation.

- Disease-Modifying Antirheumatic Drugs (DMARDs): If rheumatoid arthritis or another autoimmune condition is diagnosed, DMARDs can help slow disease progression.

- Corticosteroids: These can be used to reduce inflammation quickly.

- Biologics: For autoimmune conditions, biologic medications can target specific pathways in the immune system.

2. Physical Therapy: Engaging in physical therapy can help maintain joint function and reduce stiffness. A physical therapist can provide exercises tailored to your condition.

3. Joint Injections: Corticosteroid injections directly into the affected joints may provide temporary relief from inflammation and pain.

4. Surgery: In severe cases, surgical intervention may be necessary to repair or replace damaged joints.

5. Lifestyle Modifications: Maintaining a healthy weight, engaging in low-impact exercises, and following a balanced diet can help manage symptoms.

Conclusion
Given the complexity of your symptoms and the potential for an autoimmune or inflammatory condition, it is crucial to seek a thorough evaluation from a rheumatologist or a specialist in autoimmune diseases. They can perform specific tests, such as blood tests for inflammatory markers or imaging studies, to determine the exact cause of your symptoms and develop an appropriate treatment plan. Early intervention is key in managing these conditions effectively and preventing further joint damage.

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