Rheumatoid Arthritis Rash
Rheumatoid arthritis (RA) is typically associated with joint pain, but as an inflammatory autoimmune disorder, it can affect the entire body. Some people develop a rash or other skin problems.
Some of these problems occur only in advanced cases of RA. Others can appear early in the course of the disease and may even help a doctor diagnose a new case of RA.
Rheumatoid Arthritis Rash Causes
Inflammation of the blood vessels affects the flow of blood to the skin. This can lead to rashes and other skin symptoms. Rheumatoid arthritis rashes tend to happen during a flare-up of disease activity or in people with severe disease. Some people may develop a rash due to an allergy to an RA medication.
Rheumatoid Arthritis Rash Symptoms
What does a rheumatoid arthritis rash look like? That depends on the type of rash. Below are four skin conditions associated with RA that may cause rash-like symptoms. Symptoms typically occur on both sides of the body.
Palmar erythema, or “red palms,” can stem from a variety of health conditions. About 60% of people with RA experience it. It happens when small blood vessels in the hand become dilated, which draws more blood to the surface.
Signs include redness of both palms that may extend to the fingers. The redness may be accompanied by a slight feeling of warmth. Palmar erythema does not typically hurt or itch.
You’ll notice that the redness fades if you press on the skin. The degree of redness can also change with fluctuations in air temperature, when you raise your hand or when you’re feeling stressed.
This condition typically develops in people who have had severe RA for at least 10 years. It is less common than it once was thanks to more effective systemic treatments for RA.
Rheumatoid vasculitis happens when inflammation causes small- and medium-sized blood vessels to narrow. This interferes with blood flow to the skin. Smoking can increase the risk of developing rheumatoid vasculitis.
Signs and symptoms include:
- Spots, pits or sores around the fingernails
- Redness, swelling and pain in the fingers or fingertips
- A painful red rash, typically on the legs, if larger blood vessels become inflamed
- Skin ulcers
Rheumatoid vasculitis affects the entire body, not just the skin. Other signs and symptoms include:
- Numbness or tingling of the hands or feet
- Cough, shortness of breath
- Chest pain
- Abdominal pain
Rheumatoid neutrophilic dermatitis
Rheumatoid neutrophilic dermatitis is a rare skin condition associated with longstanding RA. It usually presents as a raised red, blue or purple rash on both arms and/or legs. It can also appear on a single limb or on the torso. In severe cases, neutrophilic dermatitis can cause blisters or skin ulcers.
Interstitial granulomatous dermatitis
Interstitial granulomatous dermatitis is another rare type of skin condition associated with autoimmune diseases like RA.
It causes red or skin-colored bumps or patches, usually on the chest, abdomen or back but sometimes on the limbs. Patches may change in size or shape over days or months. This condition is usually painless. Some people may experience mild itching or burning.
Rheumatoid Arthritis Rash Diagnosis
Not all rashes in people with rheumatoid arthritis are related to their RA. For instance, rashes from shingles, psoriasis and contact dermatitis are common. Since rashes can be difficult to identify on your own, see a board-certified dermatologist for an accurate diagnosis.
Your doctor may be able to identify the rash based on symptoms and appearance. In some cases, the provider may want to perform a skin biopsy. Biopsy is the only definitive laboratory test for rheumatoid vasculitis.
If you suspect your RA medication may be the cause of your rash, keep taking it until you speak with your rheumatologist. Your rheumatologist and dermatologist can work together to manage your RA and keep your skin as healthy as possible.
Rheumatoid Arthritis Rash Treatment
Skin conditions in RA could mean that the disease is worsening, or that the medication you take to manage your RA isn’t working well or is causing a skin reaction. Treatment depends on the cause and severity of symptoms and may involve a combination of topical medicines and medicines to manage the underlying inflammation.
Your rheumatologist may start with a review of your current treatments to see if they should be adjusted or changed.
Palmar erythema: There’s no specific treatment for palmar erythema, but systemic treatment for RA may improve symptoms.
Rheumatoid vasculitis: Treatment may include topical antibiotics (to prevent infection), corticosteroids, immunosuppressants or biologic agents.
Rheumatoid neutrophilic dermatitis and interstitial granulomatous dermatitis: Treatment may include topical or oral corticosteroids, a drug called dapsone (which has antibiotic and anti-inflammatory properties) and hydroxychloroquine.
If your rash is painful, ask your doctor which over-the-counter pain medicines are best for you. In some cases, stronger pain relievers can be prescribed.