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Rheumatoid arthritis (RA) is a type of inflammatory arthritis known for causing joint symptoms, including pain, swelling, and stiffness. However, studies have shown that 10 percent to 20 percent of people with RA experience symptoms outside of their joints. Some people with RA have peripheral neuropathy, a group of disorders caused by damage to the peripheral nervous system.
Peripheral neuropathy can cause symptoms like increased sensitivity, muscle weakness, twitching, and painful sensations. If you have any of these symptoms, talk to your doctor. They will be able to figure out the cause of any new or worsened symptoms and work with you to find the right treatment.
Peripheral neuropathy is a general term that refers to a group of disorders caused by damage (lesions) affecting the peripheral nervous system. The peripheral nervous system connects the nerves from the brain and spinal cord to the rest of the body. These nerves run to the limbs, hands, and feet, as well as the internal organs, joints, skin, and more. Damage with peripheral nerve involvement can cause symptoms like pain and numbness.
Peripheral neuropathy may be classified based on where the nerve damage is. The most common form of the condition is polyneuropathy — damage to many peripheral nerves at once. Mononeuropathy, on the other hand, is damage to a single nerve or nerve group.
Peripheral neuropathy may also be categorized by the type of damage and symptoms a person has. Carpal tunnel syndrome is one of the most well-known forms of the disorder. Carpal tunnel syndrome is often caused by repetitive tasks, such as typing on a keyboard. It can cause numbness, tingling, and weakness in the hand, wrist, and arm.
Some people with rheumatoid arthritis develop mild forms of peripheral neuropathy, such as carpal tunnel syndrome, due to the inflammation in hand joints and tendons. Their symptoms can be symmetric (on both sides of the body) or asymmetric (on only one side of the body). Peripheral neuropathy in RA may occur in the upper limbs, the lower limbs, or both.
Peripheral neuropathy can cause many symptoms, including pain, abnormal sensations, and muscle weakness. These symptoms often mimic or overlap with symptoms of RA, making it hard to figure out which condition is causing your symptoms.
The symptoms of peripheral neuropathy typically begin with numbness and pins-and-needles sensations in the fingers or toes. These sensations may spread into the hands and feet, causing sharp, throbbing, burning, freezing, or shooting pain. This pain can be constant or occasional.
Some people with peripheral neuropathy find that their symptoms develop quickly and suddenly, while others develop symptoms slowly for several years. The symptoms you experience may depend on which peripheral nerves have been damaged.
Other symptoms of peripheral neuropathy include:
Members of myRAteam have described their experiences with peripheral neuropathy. One member wrote, “My neuropathy started in my feet, then went up to my knees and up from my fingers to my elbows.” Another shared that peripheral neuropathy “was my first sign that I had an autoimmune disease at age 24.”
Members have also shared the variety of sensations they experience with peripheral neuropathy. One noted, “Your feet are numb to feeling, yet there is awful nerve pain. I’ve heard it compared to shingles pain.” Another member shared, “I have no feeling in my ring finger and pinky on both hands. It’s strange to not have feeling in them. Makes them seem weaker than they are.”
Peripheral neuropathy develops when the peripheral nerves outside the brain or spinal cord are damaged or destroyed. This damage prevents the nerves from properly transmitting nerve signals to the muscles, skin, and other parts of the body, resulting in muscle weakness, tingling, and numbness. Several factors may cause a person with rheumatoid arthritis to develop peripheral neuropathy.
Many people with RA have anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are immune proteins linked to RA. These antibodies are part of the body’s mistaken immune response and are associated with more severe disease in some people. Research shows a strong link between anti-CCP antibodies and peripheral neuropathy in people with RA.
Nerve entrapment, also called entrapment neuropathy or compression neuropathy, happens when the nerves have become compressed and restricted due to joint damage or swelling. People with RA sometimes develop entrapment neuropathies, including carpal tunnel syndrome and tarsal tunnel syndrome (compression of a nerve that runs along the inside of the ankle). Entrapment neuropathies can develop when the tissues surrounding a joint have become swollen and damaged by RA, leading to pressure on nearby nerves.
Some medications may be associated with peripheral neuropathy in people with RA. One myRAteam member wrote that their doctor determined that their neuropathy was a side effect of taking leflunomide (Arava). “I stopped taking it,” they wrote, “and the neuropathy has gotten a lot better.” If you experience peripheral neuropathy while taking RA medications, contact your doctor right away.
Another class of medications for RA, anti-TNF-alpha treatments, has been associated with rare cases of polyneuropathy. If you experience new weakness, numbness, or tremor while taking one of these medications, let your healthcare team know.
Sometimes, vasculitis (inflammation of the blood vessels) may contribute to peripheral neuropathy in people with RA. When blood vessels become inflamed, they can reduce blood flow to nerves and lead to nerve damage.
Treatment for peripheral neuropathy in RA aims to manage the underlying rheumatoid arthritis and relieve neuropathic symptoms. Your usual treatments for rheumatoid arthritis, such as disease-modifying antirheumatic drugs (DMARDs), may help prevent or relieve peripheral neuropathy symptoms. Your healthcare provider may also recommend the following to manage neuropathy.
Certain medications may help relieve symptoms of peripheral neuropathy.
Medications typically used to treat epilepsy, including gabapentin and pregabalin, may help relieve nerve pain in peripheral neuropathy. Your healthcare provider can help you decide whether one of these medications is right for you and what dose to start with.
Certain types of medication for depression, called tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly among the first medications used to treat peripheral neuropathy alongside gabapentin and pregabalin. TCAs for peripheral neuropathy include nortriptyline, and SNRIs include duloxetine and venlafaxine.
Certain creams contain a chemical called capsaicin, the compound that gives foods like hot peppers their spiciness. While the low-dose over-the-counter capsaicin cream can lead to mild relief at best, the high-concentration capsaicin 8 percent patch is a good choice for nerve pain in one specific area.
Although these creams may cause burning or irritation, they may ease peripheral neuropathy symptoms. Topical patches containing the anesthetic lidocaine may also provide pain relief.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are not generally useful in reducing nerve pain. However, they may help relieve mild to moderate discomfort associated with peripheral neuropathy.
Certain therapies and procedures may also help relieve the symptoms of peripheral neuropathy, including physiotherapy, transcutaneous electrical nerve stimulation (TENS), plasma exchange, and surgery. Therapies and procedures should be used with caution in inflammatory diseases such as rheumatoid arthritis, as some of them can make the inflammation worse and cause a disease flare.
Physiotherapy can help improve movement if you experience muscle weakness with RA and peripheral neuropathy. Assistive and supportive devices, such as braces, canes, walkers, and wheelchairs, can also help support movements during physiotherapy and daily activities.
A TENS unit is a battery-powered device that can help relieve pain. It works by delivering low-voltage electrical impulses through electrodes placed on the skin. The recommended length of time of each TENS session may vary, as evidence is mixed. Although you can buy over-the-counter TENS units at your local pharmacy, it’s best to try it first with guidance from a trained clinician.
Other procedures, like plasma exchange and intravenous immunoglobulin (IVIG), are not routinely used for RA-related neuropathy. These more invasive options are usually used only for certain immune-related neuropathies that don’t improve with other treatments. Plasma exchange helps clean the blood by removing antibodies and other proteins that lead to inflammation. IVIG involves high levels of immunoglobulins, which are proteins that function as antibodies. These procedures should be done under a specialist’s care.
If your peripheral neuropathy is caused by pressure on your nerves, you may need surgery to help relieve the pressure. For example, surgery may be used to treat nerve entrapment, such as carpal tunnel syndrome. Your healthcare provider can help you weigh the risks and benefits and decide whether surgery makes sense based on your symptoms and test results.
Peripheral neuropathy can be an added challenge for people living with rheumatoid arthritis, especially when symptoms overlap with joint pain and stiffness. If you notice new nerve-related symptoms or changes in how your body feels, talk with your healthcare provider. Getting checked early can help find the cause and guide treatment that may ease symptoms and help you feel better day to day.
On myRAteam, people share their experiences with rheumatoid arthritis, get advice, and find support from others who understand.
Have you had nerve symptoms while living with RA? Let others know in the comments below.
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I suffer with the needle burning numbness and pain in my body all over I’ve had two spinal surgery and Knee and reverse shoulder replacement in pain 24/7 off balance and on a walker depending I’ve… read more
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