While rheumatoid arthritis (RA) primarily affects the joints and the connective tissues, other areas of the body can also be involved. More than 1,000 myRAteam members report skin rashes as one of their RA symptoms. “I have a horrible rash that flares up at times on both arms,” one member said. Another said, “I have had a rash on and off on my right forearm for six months now.”
When parts of the body besides the joints are affected by RA, the symptoms are called extra-articular manifestations. These can be divided further into two categories: general manifestations, like thinner and paler skin overall, and specific manifestations, like a nodule under the skin.
One of the most common general rashes for people with rheumatoid arthritis is reddened palms, or palmar erythema. One study found that almost 60 percent of those with RA reported palmar erythema at some point. It usually occurs on both hands and is not painful or itchy. The hands may feel slightly warmer than usual.
Eczema (atopic dermatitis) is a common skin condition characterized by an intensely itchy, red or purple rash. While eczema can occur without rheumatoid arthritis, one study found the rates of RA in those with atopic dermatitis were 72 percent higher than in the general population. Researchers are studying whether some forms of eczema are an autoimmune disease.
A small percentage of those with rheumatoid arthritis may develop a specific complication called cutaneous vasculitis. “I had this rash on my ankles and legs when my RA flared up, but they diagnosed it as vasculitis,” one myRAteam member said.
Cutaneous vasculitis is also sometimes referred to as rheumatoid vasculitis. It usually appears as a purplish rash (purpura) on the skin. In more severe cases, skin ulcers may appear on the legs. The rash is often accompanied by lack of sensation, numbness, or tingling in the affected area. Other parts of the body may also experience symptoms of rheumatoid vasculitis: the liver or spleen may be enlarged, and hematuria (blood in urine) can occur as well. Cutaneous vasculitis is an emergency, and you should talk to your rheumatologist about it right away if you notice symptoms.
Sweet's syndrome and pyoderma gangrenosum, although uncommon, can also cause a rash for people with RA. Sweet’s syndrome causes a painful, blistering rash with mucosal lesions. Pyoderma gangrenosum causes an ulcerative skin rash with bluish borders and the appearance of new ulcers with minor damage to the skin. Sweet's syndrome and pyoderma gangrenosum are serious, and they require intervention from your health care provider. Contact your doctor immediately if you are experiencing these symptoms.
Rashes might not seem like the worst symptom of RA, but myRAteam members have reported a variety of problems with RA skin conditions.
Eczema, Sweet's syndrome, and pyoderma gangrenosum are all related to autoimmune problems. Both Sweet’s syndrome and pyoderma gangrenosum are neutrophilic dermatoses, inflammatory skin conditions related to an overload of a type of white blood cell called neutrophils. Neutrophils naturally produce an inflammatory response to infection. In an autoimmune condition, the skin may be attacked as foreign by the immune system, leading to neutrophils overwhelming the skin and causing inflammation — as if the skin was infected.
While the precise cause of eczema is not known, it is generally considered to be an autoimmune response that causes inflammation of the skin. Other autoimmune conditions besides RA have been associated with eczema, including Crohn’s disease and ulcerative colitis.
Rheumatoid vasculitis is caused by inflammation of both small- and medium-sized blood vessels, often as part of an RA flare-up. It usually occurs in people who have had severe RA for more than 10 years. Certain factors play a part in those who are at higher risk for this complication. Most people who develop rheumatoid vasculitis have a high rheumatoid factor in their blood (an autoantibody present in many people who have RA) and many smoke cigarettes.
The first sign of rheumatoid vasculitis is rheumatoid nodules, lumps in the skin near affected joints (a possible sign of joint damage). Having rheumatoid nodules does not mean rheumatoid vasculitis will develop. While around a quarter of people with RA will eventually experience rheumatoid nodules, less than 5 percent will develop rheumatoid vasculitis.
Palmar erythema, reddening in the palms, has a wide variety of causes. When someone with RA experiences red palms, however, it is most likely to be as a result of an autoimmune response. It can also be caused by medication taken to treat RA.
Rashes are sometimes a side effect of medication for rheumatoid arthritis. Methotrexate is known to cause rashes as a side effect. Some myRAteam members have reported that some other drugs also caused rashes. “I would randomly develop rashes on my knees and shoulders when I was on Humira. The rashes stopped occurring once I stopped Humira,” one member said.
Depending on the type of rash, treatment options may vary. Palmar erythema may not be treated at all if it is not causing distress. If the reddening of the palms is caused by a drug, your doctor may recommend stopping that medication.
Rheumatoid vasculitis is usually treated by management of the underlying RA. If the vasculitis is confined to the fingertips and skin around them, antibiotic cream along with pain control is often prescribed. Rheumatoid vasculitis symptoms indicate that your current RA treatment is not working well. It is important to contact your doctor if you have symptoms of rheumatoid vasculitis.
Minor cases of eczema may be treated with topical ointments. More severe cases are treated with immunosuppressant drugs and biologics, including some disease-modifying antirheumatic drugs (DMARDs) that are also used to treat rheumatoid arthritis.
Sweet's syndrome is often treated with oral corticosteroids. The symptoms often go away after a few days of treatment, but to prevent the rash from coming back, steroids are usually taken for several weeks or months afterward. Topical corticosteroids may also be used in some cases.
Pyoderma gangrenosum has a variety of treatments depending on how advanced the rash is. In earlier phases, topical corticosteroid ointments are usually combined with oral anti-inflammatory antibiotics, like doxycycline or Dynacin (minocycline). Larger ulcers are treated with steroids like prednisone and, in severe cases, surgery to remove the affected skin.
Have you ever had a rash related to rheumatoid arthritis? Do you have any tips to deal with rashes? Comment below or start a conversation on myRAteam.