DIP Psoriatic Arthritis (DIP PsA) Symptoms and Treatment

Distal interphalangeal predominant (DIP) psoriatic arthritis (PsA) primarily affects the small joints in the fingers and toes closest to the nails. DIP PsA can ultimately become a condition that is serious enough to cause marked disability.

In this article, learn the symptoms of DIP PsA and various treatment options, including medication, surgery, and home remedies.

What Are the Symptoms of DIP PsA?

Symptoms of DIP PsA include:

• Stiffness of the distal joints, especially in the morning and after periods of rest
• Reduced range of motion
• Pain and swelling of the fingers or toes
• Sausage-like appearance of the fingers or toes
• Tendon or ligament pain
• Nail changes, including white spots, detachment, discoloration, tenderness, crumbling, and pitting (small indents)

Psoriatic arthritis is known for starting at the distal interphalangeal (DIP) joints, which are the joints closest to the fingernails and toenails. Stiff and inflamed fingers make it harder to perform simple tasks like zipping a jacket or opening a jar. Stiff and swollen toes make walking and standing for long periods painful.

Swelling associated with DIP PsA usually affects the entire finger or toe. It is asymmetric, meaning it affects only one side of the body. That means if all the joints in one hand are affected, the other hand may not be affected at all, or four or fewer digits are involved. However, research shows PsA can also be symmetrical, involving the joints on both sides of the body. Moreover, DIP PsA occurs more frequently in the toes.

How Is DIP PsA Treated?

DIP psoriatic arthritis can be painful and affect quality of life. However, there are several approaches to treating the symptoms of this painful condition, from medication and surgeries to home remedies that anyone can try.

Medical Therapies

There are a few different medical approaches to treating DIP PsA.

• Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation. 
• Corticosteroid injections can reduce inflammation and treat pain from DIP PsA. 
• Disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors can reduce symptoms and prevent disease progression in those with moderate to severe symptoms.
• Physical and occupational therapy can help preserve and improve range of motion and reduce pain, allowing patients to improve their quality of life.
• Surgery is considered the last option to alleviate severe pain and repair joint damage. However, joint damage from DIP PsA might recur, especially in the fingers.

Home Remedies

In addition to the medical treatments for DIP PsA, several home remedies can help relieve symptoms. Some include:

• Cold therapy: An ice pack or a bag of frozen vegetables can help alleviate swelling in the hands and fingers. Alternating between cold and heat or off and on every 10 minutes is a good idea. A frozen water bottle rolled under the foot can reduce swelling and massage the foot, heel, and toes.
• Splinting and orthotics: Using splints and orthotics can help prevent deformity of the joints in DIP PsA. Often, wearing splints just at night is adequate.
• Nail and cuticle protection and maintenance: Because DIP PsA affects the nails, they should be trimmed, filed, and moisturized regularly. If nails are professionally done, cuticles should not be treated to avoid tiny tears. Skin injuries—no matter how small—can trigger PsA symptoms and increase the chance of infection in people taking immune-suppressant drugs.
• Soaking hands and feet: A warm hand or foot soak can alleviate pain and swelling in hands and feet. Soaks should be short to avoid drying the skin and worsening skin symptoms. It's also a good idea to moisturize skin after soaking.
• Keep feet dry: To avoid sweating in the feet, try moisture-wicking socks. These socks—made from nylon, polyester, or wool—pull sweat from the skin to the fabric and evaporate wetness. If shoes are wet, remove them immediately and allow them to completely dry out before putting them back on.
• Pick the right shoes: Wide-width and open-toe shoes are generally recommended for people with different types of arthritis. Pointy-toe shoes and high heels should be avoided because they cramp feet and push toes forward.

Hand Exercises

In addition to physical and occupational therapy, there are hand exercises you can do to help maintain range of motion and strength. Here are five to get you started:

• Finger curls: Starting with your fingers extended, roll each finger inward, starting with the DIP joint (the one closest to your fingernail), then your middle finger joint, and finally, the joint closest to your palm. Once all fingers are curled inward and you are making a fist, hold for a few seconds, then straighten the fingers one at a time in reverse order (first, straighten the joint closest to your palm, then midfinger, then the DIP joint).
• Gentle fist: Using a hand therapy ball, grip your fingers gently around the ball: release and repeat.
• Grip strengthener: Using a hand therapy squeeze ball, grip the ball, and squeeze as hard as you can for five seconds; release and repeat.
• OK exercises: Hold your hand so your fingers are extended and your thumb points toward the sky. Bend your pointer finger toward your thumb to make the "OK" sign. Repeat with each other finger a total of five times for each finger.
• L-shape: Place your hand on a table so the side of your pinky is against the table, and your thumb is pointed to the sky. Bend your four fingers so your hand makes an "L" shape. Hold for two seconds and straighten your fingers out. Repeat 10 times for each hand.

Summary 

Distal interphalangeal predominant psoriatic arthritis can cause pain and disability and affect daily routines and quality of life. There are many ways to treat the condition and cope with pain and swelling. While there is no cure for DIP PsA, treatment can help the condition become more manageable and prevent joint deformity and disability.