The nails giveth the diagnosis

You may wonder why doctors stare at your nails.

There are a number of reasons the appearance of your nails may give us a clue as to the problem you're presenting with (link for some examples).

As a rheumatologist, I'm mainly checking out this part of your body to look for:

• Pitting: these are little holes or depressions in your nails.

• Onycholysis: lifting of the nails, separation from the nailbed.

• Ridging: raised lines or ridges that run up & down the fingernail, and less commonly, horizontally.

These are classic nail signs of psoriasis. They can even occur in the absence of skin disease.

Psoriatic nail disease has implications.

In most, it means an increased likelihood of rheumatic disease.

This means that the presence of these nail changes in a patient with inflammatory arthritis, and/or recurrent tendinopathy/enthesopathy, and/or spinal pain & stiffness is significant.

In these patients, psoriatic arthritis needs to be considered as a diagnosis.