“Can someone tell me if muscle cramps, knots, tremors, and twitching are normal? I get them daily and am not sure what to do,” a member of myRAteam asked.

Muscle twitches — also called muscle spasms or muscle cramps — are a common topic among myRAteam members. These sudden, involuntary movements can disrupt sleep, make exercise harder, and interfere with daily routines.

Other members have shared similar experiences:

• “Lying in bed, I noticed involuntary toe movements/twitching. The directions my toes bend can hurt, but standing up stops the twitch.”
• “I’m having a bit of a flare-up, and I noticed that I started twitching a lot in my hands, well, actually my whole body, but I am much better than I was a few weeks ago.”
• “I’m so frustrated. I’ve been suffering from muscle spasms, and no one can tell me why. My leg muscle keeps going into a spasm. With RA, you expect joint pain, but what bothers me even more are the muscle spasms.”

Fortunately, there are ways to manage muscle spasms effectively. Here we discuss what causes muscle twitches and spasms with rheumatoid arthritis (RA) and how you can manage your symptoms to improve your quality of life.

What Causes Muscle Twitches and Spasms With Rheumatoid Arthritis?

There are several different possible causes of muscle twitches or spasms with RA. These may be linked to RA symptoms, comorbidities (coexisting health conditions), or side effects from medications commonly used to treat RA.

Muscle Weakness

One common cause of RA muscle spasms is muscle weakness. Research shows that people with RA may have 25 percent to 70 percent less muscle strength than people without the condition. This weakness may be due to muscle atrophy (loss of muscle mass) and inflammation, both of which can result from reduced physical activity.

People with RA often experience joint swelling and pain, especially when their condition isn’t well managed. As a result, they may limit movement or favor certain joints over others. Over time, this can lead to muscle loss in areas that are used less.

In some cases, muscle weakness and spasms may be linked to high levels of calcium in the body. Researchers are still working to understand why this occurs in people with RA.

Another potential cause is an imbalance of electrolytes, which are essential minerals that help muscles and nerves function properly. If your levels of certain electrolytes are too low or too high, you may be more likely to experience spasms or cramps.

Key electrolytes involved in muscle and nerve function include:

• Calcium
• Magnesium
• Potassium
• Sodium
• Phosphate

Restless Legs Syndrome

Restless legs syndrome (RLS) is a condition that causes an uncomfortable urge to move the legs, often described as crawling, itching, pulling, or tingling sensations. These feelings typically happen during rest — especially in the evening or at night — and can interfere with sleep.

About 27 percent of people living with RA experience RLS. In comparison, the condition affects between 3.9 percent and 14.3 percent of people without RA. Sleep disorders like RLS are believed to be more common among people with connective tissue disorders, including RA.

Although restless legs syndrome primarily affects the nervous system, it also involves the immune system and sleep regulation. RA is an autoimmune disease in which the immune system mistakenly attacks healthy tissues, causing inflammation throughout the body.

Conditions like RA and RLS can make it harder to get restful sleep. Poor-quality sleep, in turn, can increase RA-related fatigue and inflammation. Health experts believe that sleep disturbances may be more common in people with RA due to the close connection between sleep and immune system function.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an autoimmune condition that causes muscle pain and stiffness, particularly in the shoulders, upper arms, neck, and hips. The symptoms are often worse in the morning or after periods of inactivity.

Like RA, polymyalgia rheumatica is an autoimmune rheumatic disease. PMR is the second most common autoimmune rheumatic disease after RA.

RA and PR can cause similar symptoms. This overlap may lead to one condition being mistaken for the other, even by healthcare providers.

In some cases, PMR may also lead to muscle weakness, which can increase the risk of muscle twitches or spasms.

Polymyositis

Polymyositis is a rare autoimmune condition that causes chronic inflammation in the muscles, leading to weakness. It most often affects muscles closest to the trunk, including shoulders, upper arms, hips, thighs, and the neck. It belongs to a group of conditions known as inflammatory myopathies, which affect the muscles that help you move.

Having RA increases your chances of developing polymyositis. People who live with both conditions may be more likely to experience muscle spasms or twitches because of their weakened muscles and ongoing inflammation.

Peripheral Neuropathy

Peripheral neuropathy refers to a group of conditions that affect the peripheral nervous system (the network of nerves outside the brain and spinal cord). These nerves help control movement and sensation by carrying signals between your brain, spinal cord, and muscles.

There are many possible causes of peripheral neuropathy, and RA is one of them. While it’s estimated that about 2.4 percent of people worldwide have some form of peripheral neuropathy, nearly 50 percent of people with RA may develop it.

When nerve signals are disrupted, it can lead to muscle-related symptoms such as weakness, twitching, or muscle loss. These symptoms can make movement more difficult and affect quality of life.

Certain Medications

Some medications — including those used to treat RA — may contribute to muscle twitches or spasms. One reason is that certain drugs can cause an electrolyte imbalance, which may lead to muscle weakness, cramps, or twitching.

Medications known to affect electrolyte levels include:

• Corticosteroids (steroids)
• Antibiotics
• Chemotherapy drugs
• Diuretics and laxatives
• Statins (used to treat high cholesterol)

Some disease-modifying antirheumatic drugs (DMARDs) used to treat RA have side effects that lead to muscle twitching. For example:

• Methotrexate, a commonly used DMARD, may rarely lead to liver damage (such as cirrhosis), which in turn can disrupt electrolyte balances.
• Leflunomide, another DMARD, has been linked to peripheral neuropathy.

If you notice new or worsening symptoms after starting a medication, it’s important to talk with your doctor. They can help determine whether your medication may be a factor and discuss next steps.

Managing Muscle Twitches and Spasms With Rheumatoid Arthritis

For occasional rheumatoid arthritis muscle twitching, several strategies can help manage discomfort and reduce pain. However, it’s important to know how to tell the difference between muscle spasms and other RA symptoms, like joint stiffness or nerve pain, because they may need different types of treatment.

During a spasm, your muscles will twitch, cramp, or jerk involuntarily. If your muscle spasms are painful, the pain may be sharp and range from mild to severe in intensity.

In contrast, joint stiffness usually causes a dull, aching pain, while nerve pain with spasms or twitching may feel like a burning, stabbing, or electric sensation.

Clearly describing what you’re feeling can help your doctor figure out the cause and suggest the best way to treat it.

Muscle Relaxants

You and your healthcare provider may decide that you should try using muscle relaxants for muscle spasms and related pain. These medications may provide short-term relief. However, it’s important to talk with your doctor before starting any new treatments, including over-the-counter medications or supplements.

Medications sometimes used to reduce muscle spasms include:

• Benzodiazepines, including diazepam (e.g., Valium) or lorazepam (e.g., Ativan)
• Non-benzodiazepines like metaxalone (e.g., Skelaxin) or orphenadrine (e.g., Muscol)

While these drugs may help ease symptoms, the evidence on their effectiveness in treating RA-related muscle spasms is mixed. One review found that benzodiazepines may not significantly improve muscle spasm-related pain in people with RA. Additionally, though non-benzodiazepines are sometimes used to manage pain in other conditions involving muscle spasms, there’s limited research on how well they work for people with RA.

When prescribed, relaxants are often used in combination with other treatments, not on their own.

Nonmedication Therapies

Nonmedication therapies can also play an important role in managing muscle twitches, spasms, or related discomfort. Your healthcare team may recommend interventions to reduce how often spasms happen and how intense they feel.

Options may include:

• Hot or cold treatments, which may help reduce muscle cramping
• Electrical stimulation, which sends small pulses to targeted muscles to help relax spasms or improve movement
• Range-of-motion exercises and guided activity plans, which can help maintain flexibility and prevent stiffness
• Assistive devices, such as braces or splints, which support weakened muscles or joints
• Massage therapy, which may help relax tight muscles and improve circulation

If you work with a physical therapist or occupational therapist, they can also share progress notes directly with your rheumatologist to keep your RA care team updated and coordinated.

Proper Hydration

Dehydration can cause muscle twitches or spasms. That’s why staying well-hydrated is an important part of managing muscle health.

Make sure you’re drinking enough water throughout the day, especially if you’re active, taking medications that affect fluid levels, or living in a hot climate.

If you’ve lost fluids due to sweating, illness, or certain medications, your electrolyte levels may drop. In that case, you might benefit from a sports drink or electrolyte-replenishing product to help restore balance and reduce the risk of muscle cramps.

Talk With Your Doctor

Talk with your rheumatology provider if you’re experiencing regular or uncomfortable muscle spasms, especially if they affect your quality of life. It’s important to discuss any spasms that are frequent, long-lasting, very painful, or accompanied by swelling or skin changes.

See a healthcare provider right away if you:

• Have severe pain
• Begin having muscle spasms after coming into contact with something potentially poisonous
• Have muscle cramps throughout your body
• Think your muscle twitches may be related to an underlying medical condition
• Have muscle pain with dizziness, trouble breathing, high fever, stiff neck, or severe muscle weakness that affects your daily activities

Find Your Team

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Do you have muscle twitches with RA? Share your experience in the comments below, or start a conversation by posting on your Activities page.