From everydayhealth.com
When PsA impacts your hands, this can reduce strength, dexterity, and fine motor skills, all of which can interfere with your daily life.
“In severe cases, it may be almost impossible to open and close the hand or make a fist,” says Norman Gaylis, MD, a rheumatologist and board member of the American College of Rheumatology in Miami. “This drastically reduces the quality of life when people are unable to complete household chores, pursue hobbies they enjoy, or take care of their daily hygiene needs because they are unable to use their hands.”
How PsA Takes a Toll on Hand Function
These are the ways that PsA can change your hands:
- Reduced Strength and Muscle Atrophy When your hands are painful, swollen, or stiff, you might use them less. This can lead to a loss of strength and muscle mass.
- Stiffness Inflammation from psoriatic arthritis can make your hands feel stiff. This is due to synovitis (inflammation of the joint capsule) and enthesitis (inflammation where your tendons and ligaments attach to your bones).
- Difficulty Gripping Grip strength decreases as the severity of psoriatic arthritis increases. This affects the ability to both grasp an object with your whole hand, like when you pick up a water bottle, and pick up small items with your thumb and index finger.
- Swelling Psoriatic arthritis can cause severe swelling in the fingers, called dactylitis. You might also hear this called “sausage fingers.”
- Nail Changes Up to 80 percent of people with PsA experience changes in their fingernails. “With some patients, nails start to look broken, become brittle, and even separate from the nail bed,” says Dr. Gaylis. Not only can this feel embarrassing but it can be painful and make it difficult to use the tips of your fingers (like you do when typing on a computer or phone).
- Deformities Actual deformities in the hands are rare these days, thanks to better treatment. However, they can still develop if psoriatic arthritis isn’t treated. “In the most severe cases, arthritis mutilans develops and dissolves tissue and bones in the fingers,” says Gaylis. This occurs in about 5 percent of psoriatic arthritis cases.
- Loss of Fine Motor Skills Hand swelling, pain, and stiffness can all make it challenging to perform tasks that require precision, dexterity, and coordination. You might find it increasingly difficult to manipulate small objects like zippers or buttons.
All these symptoms add up to real difficulty completing functional tasks in your everyday life.
Who Can Help Restore Hand Function
There are a few health professionals you can reach out to if psoriatic arthritis is affecting your hands. The primary ones are rheumatologists and certified hand therapists (CHTs).
Rheumatologists are doctors who specialize in autoimmune diseases and inflammatory diseases that affect the joints, bones, and muscles. If you’re diagnosed with PsA, you’ve most likely already seen a rheumatologist.
“Fortunately, rheumatologists can treat psoriatic arthritis with many new biologics and medicines that are very effective,” says Gaylis. These medications help manage inflammation and swelling from psoriatic arthritis, which can noticeably improve hand function.
CHTs are also an essential part of the team for anyone with psoriatic arthritis affecting their hands. These health professionals can either be occupational therapists or physical therapists who’ve gone through extra training to specialize in treating hand conditions like psoriatic arthritis.
A CHT will assess your mobility and function and give you tailored treatment that might include splints, exercises, and assistive devices. You can ask your doctor to refer you to a CHT, or depending on your health insurance, you may be able to make your own appointment.
Strategies to Improve Strength and Control
We use our hands constantly, from turning on the tap at a sink to sliding a credit card out of a wallet. Bringing back strength and control to your hands can improve your quality of life.
Therapeutic Exercises
Therapeutic exercises can reduce pain and improve coordination, strength, and function. Common exercises for PsA include the following:
- Isometric Exercises These are static exercises during which your muscles stay the same length. “Isometric exercises are safer for the arthritic hand to perform because the joints are not moving,” says Kristin Valdes, a certified hand therapist and professor at Touro University Nevada, in Henderson, Nevada. In this type of exercise, you squeeze an immovable object, and your joints are supported by the object you’re holding. Valdes suggests squeezing a firm racquetball or tennis ball to improve grip strength.
- Passive Range of Motion With psoriatic arthritis, the fingers can flex (or “claw” inward) over time as the skin contracts. Anyone experiencing this “should use the other hand or pull their fingertips over the edge of the table to try to straighten out the fingers daily,” says Valdes.
- Tendon Gliding This set of exercises encourages smooth movement of your finger tendons within their sheath.
Be cautious when starting hand exercises with psoriatic arthritis. “If treatment is too aggressive, it can increase hand pain and cause skin breakdown,” says Valdes.
Consider seeing a CHT for a personalized program of exercises, since everyone’s psoriatic arthritis is different.
Assistive Tools
When your wrist is sore, twisting open a jar can be very painful. And when your fingers are stiff, it can feel near impossible to pick up small items. Assistive devices can help you achieve these everyday tasks with less effort and therefore less pain.
Assistive devices for psoriatic arthritis include these examples:
- Wide-grip pens or utensils
- Electronic jar or can openers
- Ergonomic kitchen tools
- Button hooks
- Elastic shoelaces
- Electric toothbrushes
- Gripping materials (to hold a mixing bowl in place, for example, or grip a lid)
- Tap turners or lever handles (to avoid twisting)
- Tongs
- Adaptive cutting boards
- Motion sensor dish soap or shampoo dispensers
Orthoses
For those seeing a hand therapist for treatment, “The therapist can also fabricate a custom orthosis to rest the joints,” says Valdes. This might look like a ring to keep your finger joint straight or a brace that wraps around your thumb.
Joint Protection and Skin Protection
Joint protection techniques, which are usually taught by a CHT, are ways to perform daily tasks so that less stress is applied to your joints. The following techniques are common:
- Practice the large joint rule. Use larger and stronger joints for tasks instead of smaller ones. Valdes gives the examples of pushing instead of pulling, carrying bags with your forearm instead of hands, and using a shoulder bag rather than a handbag.
- Limit repetitive hand movements. For example, use an electric can opener instead of a hand-operated one. You can still knit or do hobbies involving your hands, but Valdes recommends limiting these to no more than 30 minutes at a time.
- Use a light grip. “Try not to grip so forcefully that the hand fatigues easily,” says Valdes. One way to achieve this is to bulk up the handles of tools or utensils. For example, when cooking, wrap a potholder around a pot handle to make it larger; that reduces the pressure on your hand.
- Don’t forget skin protection. Applying cream to tight skin can help protect both the skin and joints.
Heat and Cold Therapy: Using Paraffin Baths for Stiffness vs. Ice for Acute Inflammation
If your fingers are swollen, try cold therapy with a cold cloth or ice pack. This can help reduce inflammation in the affected joints.
Heat therapy can’t bring down acute inflammation, but it can provide pain relief. If your hands are stiff or painful, consider applying a warm cloth or heating pad.
Lifestyle and Daily Habits
Breaking tasks into smaller, more manageable steps can help you conserve energy and manage pain. Be sure to take frequent breaks to rest your hands. “For example, when making a meal, break up cutting or chopping tasks throughout the day,” says Valdes.
You’ll also want to make a daily habit out of your therapeutic exercises, particularly stretching and range of motion exercises. However, avoid strengthening exercises when your hands are painful, says Valdes.
Overall, do your best to maintain an active lifestyle and keep up with the activities that bring you joy and meaning. You can also try new hobbies that don’t tax your hands as much, such as singing, line dancing, learning a language, or hiking.
If you’re struggling with hand pain or stiffness, talk to your rheumatologist or CHT. Your rheumatologist may adjust your medication, and your CHT can strategize personalized solutions, whether that’s a new hand splint or exercise program.
The Takeaway
- A rheumatologist can help you manage psoriatic arthritis hand symptoms with newer biologics and medications that control inflammation.
- Certified hand therapists can tailor exercises to your specific hand symptoms, recommend assistive tools, and educate you on joint protection to preserve and restore hand function.
- Therapeutic hand exercises can help enhance grip strength, dexterity, and control for performing daily tasks.




