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 extra-articular manifestations (nonjoint symptoms). As many as 85 percent of people with RA experience peripheral neuropathy — a group of disorders caused by damage to the peripheral nervous system.
Peripheral neuropathy can cause a variety of symptoms, including increased sensitivity, muscle weakness or twitching, and painful sensations. If you experience any of these symptoms, talk to your doctor. They will be able to determine the cause of any new or worsened symptoms and work with you to find the right treatment.
Peripheral neuropathy is not a disease in and of itself. Instead, it is a general term that refers to a group of disorders caused by damage to 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 (lesions) on the peripheral nerves can cause symptoms like pain and numbness in the affected areas.
Peripheral neuropathy may be classified according to where nerve damage occurs. The most common form of the condition is polyneuropathy — damage to many peripheral nerves at once. Mononeuropathy, on the other hand, refers to 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 perhaps one of the most well-known forms of the disorder. Carpal tunnel syndrome — which is often caused by repetitive tasks, such as typing on a keyboard — 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. Their symptoms tend to appear symmetrically on both sides of the body, such as in both knees or both hands. Peripheral neuropathy in RA may occur in the upper limbs, the lower limbs, or both the upper and lower limbs.
Peripheral neuropathy can cause a wide variety of symptoms, including pain, abnormal sensations (paresthesias), and muscle weakness. These symptoms often mimic or overlap with symptoms of RA, making it difficult to determine which condition is causing a person’s 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 chronic (constant) or episodic (on and off) and usually worsens at night.
Some people with peripheral neuropathy find that their symptoms develop quickly and suddenly, while others develop symptoms slowly for several years. The particular 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. As one member wrote, “I have this in my feet and up to my knees. It started with terrible cramps.” Another had a similar experience, writing, “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.”
Other members have discussed the challenges that peripheral neuropathy poses to daily life. As one member wrote, “I have this in my hands and feet as a side effect of RA. It’s a bit difficult to walk some days, and I keep changing shoes throughout the day, which helps a bit.”
Peripheral neuropathy occurs when the peripheral nerves running from the brain and 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 symptoms like muscle weakness, tingling, and numbness. Several factors may cause a person with rheumatoid arthritis to develop peripheral neuropathy.
People with RA frequently produce anti-cyclic citrullinated peptides (anti-CCP) — a type of antibody that works against the body’s normal antibodies and attacks healthy tissues. Research has found a significant relationship between anti-CCP antibodies and peripheral neuropathy in people with RA.
Nerve entrapment, also known as entrapment neuropathy or compression neuropathy, occurs when the nerves have become entrapped (compressed) and restricted. 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 occur when the tissues surrounding a joint have become swollen and damaged by RA, leading them to exert pressure on nearby nerves.
Certain medications may be associated with peripheral neuropathy in people with RA. As one myRAteam member wrote, their doctor decided that their neuropathy was a side effect of Arava (leflunomide). “I stopped taking that,” they wrote, “and it has gotten a lot better.”
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. Aside from RA treatments, your health care provider may recommend the following suggestions to manage your neuropathy.
Certain medications may help relieve symptoms of peripheral neuropathy.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help relieve mild to moderate discomfort associated with peripheral neuropathy. A rheumatologist or neurologist may prescribe stronger painkillers if these medications do not provide relief.
Medications typically used to treat epilepsy, including Neurontin (gabapentin) and Lyrica (pregabalin), may help relieve nerve pain in peripheral neuropathy.
A certain type of medication for depression known as a tricyclic antidepressant has been found helpful in relieving pain caused by peripheral neuropathy. These medications include Pamelor (nortriptyline) and doxepin.
Certain creams contain a chemical called capsaicin, the compound that gives foods like hot peppers their spiciness. Although these creams may cause a burning sensation or irritation, they may provide modest relief of peripheral neuropathy symptoms. Topical patches containing the anesthetic lidocaine may also provide pain relief.
Certain therapies and procedures may also help relieve the symptoms of peripheral neuropathy, including physiotherapy, transcutaneous electrical nerve stimulation (TENS), plasma exchange, and surgery.
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 activity.
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. TENS should be used for 30 minutes each day for about a month, according to the Mayo Clinic.
Plasma exchange helps “clean” the blood by removing antibodies and other proteins that lead to inflammation. Immune globulin therapy involves being given high levels of immunoglobulins — proteins that function as antibodies. Both of these procedures help suppress the immune system, which may be beneficial for people with inflammatory conditions like RA.
If your peripheral neuropathy is caused by pressure on your nerves, you may need surgery to help relieve the pressure. Talk to your doctor or health care team about the best plan for treating your peripheral neuropathy.
On myRAteam, the social network and online support group for people with rheumatoid arthritis and their loved ones, members discuss the chronic nature of the disease. Here, more than 147,000 members from across the world come together to ask questions, offer advice and support, and share stories with others who understand life with RA.
Have you experienced neuropathy with RA? Share your experiences in the comments below or by posting on myRAteam.