Dermatology Rheumatoid Arthritis Rheumatology

Rheumatoid arthritis: How does it affect the skin?

A chronic inflammatory disease that causes joint pain, swelling, inflammation, and nodes or hard lumps under the skin is rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition often associated with deformities in the hands and other extremities that may also affect other areas of the body, including the skin, lungs, digestive system, and probably the brain. To help relieve symptoms and avoid joint injury, it needs medical interventions.

Around 1 in 100 individuals has RA, but as part of the condition, only some can grow a rash. Such rashes can develop on different parts of the body and can cause pain. Luckily, therapies are available to help relieve the pain, redness and swelling.

What is a RA rash?

Rheumatoid arthritis
Most people with RA do not develop a rash.

Advanced cases of RA, including a rash, may cause many skin conditions. Rashes, however only impact a small percentage of individuals with RA.

RA rashes can appear on the skin as patches that are swollen, painful, and itchy. They can also be seen as pinpricks that are deep red. The most common site for a RA-related rash is on the fingertips.

In some advanced cases, painful ulcers can form from a rash. The ulcers can become infected and more complications can be caused.

Causes

Inflammation of the arteries used by the body to bring blood to different organs, including the skin and nerves, causes RA rashes.

The inflamed arteries are referred to as rheumatoid vasculitis and may cause spots on the surface of someone’s skin or patches of a RA rash.

Inflamed arteries can cause painful spots to develop on or around the fingertips. It is more likely that inflamed arteries in the legs may cause a larger area to develop a rash.

Symptoms

In the affected areas, individuals with a RA rash are likely to experience the following:

  • small to large red patches
  • pain sensation
  • swelling of the skin
  • itchiness

Advanced cases of RA rash may form ulcers or lesions.

Images

Some of the images below can be considered graphical:

  • Livedo reticularis Image credit: Nantsupawat T et al, Journal of investigative medicine high impact case reports, 2013
  • Interstitial granulomatous dermatitis
  • Ulcer on the skin
  • Palmar erythema
  • Neutrophilic dermatosis associated with rheumatoid arthritis

Other skin conditions related to RA

Several different skin disorders are associated with RA. Due to their RA, a person can experience none, one or multiple skin conditions. The following include these:

Nodule

Hard lumps that develop directly under the skin are nodules. They range from around a pea’s size to a golf ball’s size. They can develop over a person’s body’s bony or fleshy areas.

Typically, nodules are not painful but can be handled immediately to decrease their size. In rare cases, the removal of the nodule may require surgery, especially if the nodule is infected.

Medication rash

The cause of rashes on the skin of a person may be RA drugs. It is suspected that these rashes are allergic reactions to medications.

Medications that may cause a rash include:

  • tolmetin
  • celecoxib
  • sulfasalazine
  • hydroxychloroquine
  • naproxen
  • ibuprofen
  • leflunomide
  • methotrexate
  • minocycline
  • diclofenac

As a side effect of the medicine they are taking, if a person develops a rash, they should inform their doctor. The doctor can change the dosage or the drug itself to a different one, depending on the severity of the reaction.

Without talking to a doctor, it is important not to unexpectedly discontinue or decrease the drug.

An antihistamine can also be administered by a doctor to combat or decrease the reaction, or even steroids for serious reactions.

Medications used to treat RA can also make a person more susceptible to other skin problems. Any of the medicines, for instance, cause a person to bruise more easily or be more sensitive to sunlight.

Hives

Some people with RA experience hives that form on the skin that are recurrent or persistent. Hives are similar to a rash of medication, but they can develop independently of a drug. Chronic, unexplained hives are now recognized by allergists as a sign of RA.

Livedo reticularis

Livedo reticularis is a skin disease that is only occasionally connected with RA. However some studies suggest that serious underlying situations can cause livedo reticularis.

Livedo reticularis is also considered a benign rash that during colder weather, develops or becomes more noticeable. Spasms in blood vessels that create a net-like pattern of purplish lines cause the condition.

Other complications may be caused by Livedo reticularis, including:

  • ulcers
  • painful nodules
  • discoloration

The disorder may also indicate that the blood vessels contain a peripheral vascular disease or a clot.

Treatment

In certain situations, treatment for RA-induced rashes focuses on treating the underlying condition. Generally, reducing the severity of symptoms of RA can help clear up the rash.

In more serious cases of RA rash, the rash can be treated directly by a doctor. In these cases, topical antibiotics or steroids can be administered by a doctor to help treat or avoid any secondary infections.

To treat a RA rash, a person may consider skin creams and ointments. These may be used for the purpose of reducing pain or itchiness. In order to minimize swelling, topical steroids can also be suggested.

In cases where a skin rash is caused directly by a reaction to a RA medication, a doctor may advise a person on how to minimize or substitute an existing medication.