"Yellow nail syndrome" and rheumatoid arthritis

A nail dystrophy characterized by the slow growth of nails and their yellowish discoloration, the so-called yellow nail syndrome (YNS), has been associated with various conditions including rheumatoid arthritis (RA). We reviewed the histories of RA patients reported in the literature and our own cases. Most of the RA patients with YNS had been treated with the anti-rheumatic agents D-penicillamine and bucillamine. In non-treated patients, spontaneous YNS was very rare. However, pulmonary diseases, edema and other systemic complications were frequently observed in both drug-induced and spontaneous YNS associated with RA. Although the nail changes and systemic complications are probably due to different causes in drug-induced YNS, a careful search for systemic complications are necessary in patients who develop nail changes. The exact mechanism of nail growth retardation is not understood in patients with YNS, including those with drug-induced YNS. The nail changes in the latter were not associated with deficiencies of inorganic elements in either nails or sera.