In rheumatoid arthritis (RA), the immune system mistakenly attacks the body, causing inflammation and damage in the joints and sometimes other tissues. People with RA commonly experience symptoms that affect their joints, skin, and eyes. Some people with RA — including many members of myRAteam — also report experiencing mouth and/or nose sores.
These mouth and nose sores aren’t caused directly by RA. In some cases, medications used for treating the condition are the culprit. These include disease-modifying antirheumatic drugs (DMARDs), some of which suppress the immune system, causing side effects including sores in the nose and mouth.
Additionally, certain other medications used to reduce RA symptoms and control flares — such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids — can cause mouth and nose sores. In other cases, people with RA may have unrelated conditions that result in mouth and nose sores.
If you’re living with RA and develop nose or mouth sores, speak with your doctor. They may be able to help you pinpoint the cause and figure out the best treatment.
Different types of mouth sores can present different symptoms, but people with mouth sores may experience the following:
Several members of myRAteam members have shared their experiences with mouth or nose sores as a medication side effect:
Various RA medications can cause mouth and nose sores, as well as other types of side effects. Some side effects are common, while others are rare, and not everyone will experience every side effect associated with a medication.
If you have concerns about a potential side effect, always consult your health care provider. Do not discontinue a medication without a doctor’s approval. They may be able to recommend ways to manage the side effect.
Also, some drugs must be carefully tapered off rather than stopped abruptly to avoid withdrawal effects such as RA flares.
According to the Arthritis Foundation, there are three types of DMARDs:
Conventional DMARDs are chemicals that modify the immune system in a broad way by suppressing it. DMARD medications include:
These medications have the potential to cause oral and nasal sores as side effects due to their interactions with the immune system.
Biologics, also known as monoclonal antibodies, are genetically engineered medications derived from cell proteins. Rather than suppressing the entire immune system, they target specific pathways.
Several, but not all, medications in this class can have the potential side effect of mouth and nasal sores. These include:
JAK inhibitors are a newer type of DMARD. They work by targeting specific immune system molecules that promote inflammation and modifying their activity.
Currently, three medications within this class are available:
These medications could be associated with side effects, including cold sores or blisters inside the nose or on the lips. These may be due to taking methotrexate at the same time as the JAK inhibitors.
NSAIDs do not treat RA itself, but they are commonly used to manage symptoms including pain, swelling, stiffness, and fevers. Most NSAIDs, including ibuprofen and naproxen, are available over-the-counter, but some must be prescribed. One prescription NSAID, Celebrex — a formulation of celecoxib — can cause ulcers or white spots in the mouth or on the lips. Cold sores or blisters on the lips or in the nose can also be a potential side effect.
Immunosuppressive RA drugs change the way the immune system works. When a person’s immune system becomes less effective, they’re more susceptible to certain viruses, bacteria, or fungi. Before prescribing a new RA medication, a doctor will often run blood tests to look for evidence of infections.
If you have RA and mouth or nose sores, medications may not be the cause. Many common conditions can cause these symptoms.
Mouth and nose sores can last anywhere from 10 to 14 days but can sometimes persist up to six weeks.
If you are experiencing issues in managing sores, talk to your health professional for medical advice.
Consult your health care provider if you experience the following:
On myRAteam — the social network for people with rheumatoid arthritis and their loved ones — more than 188,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Are you living with RA and mouth or nose sores? Have you found ways to manage them? Share in the comments below, or start a conversation by posting on your Activities page.