Rheumatoid arthritis (RA) is a condition where the body’s immune system attacks itself and inflames the protective membrane inside the joints. This can result in symptoms that range from mild to severe.
Symptoms are mostly related to joint problems. However, you may also experience flare-ups where your symptoms are worse. This may include rashes on the body due to inflammation. These rashes are known as rheumatoid vasculitis (RV). RV is a rare complication experienced in only one percent of people with RA. In most cases, there are treatments available for rheumatoid arthritis-related rashes.
RA symptoms can vary according to the severity of the disease. RV is a less common symptom of RA. It occurs when your blood vessels become inflamed. This can lead to other symptoms that range from a red, irritated rash to an ulcer on the skin due to lack of blood flow. RV often occurs on the legs.
Other symptoms that can occur with RV include:
- appetite loss
- weight loss
- malaise, or lack of energy
Another rash-like effect of rheumatoid arthritis is palmar erythema. This causes redness in the hands. The condition typically:
- affects both hands
- isn’t painful
- doesn’t itch
- may cause increased warmth in the hands
Interstitial granulomatous dermatitis is another rash that can occur with rheumatoid arthritis. Doctors may also call this condition rheumatoid papules. Symptoms associated with the condition include red plaques or bumps that closely resemble eczema. The rash is itchy and often painful. However, interstitial granulomatous dermatitis is very rare in people with rheumatoid arthritis.
People with RA are prone to episodes known as flares. A flare indicates that there is increased disease activity in a person’s body. A person may have more symptoms associated with the condition, including fever, joint swelling, and fatigue. During a flare-up, a rheumatoid arthritis rash is more likely to occur.
When vasculitis causes a rash, this is most likely due to inflammation of small arteries and veins. This is due to high levels of rheumatoid factor in the blood.
RA can cause complications beyond a rash. Vasculitis can affect blood flow in arteries and veins. The results of severe episodes of vasculitis can be:
- numbness and tingling in the nerves, including loss of sensation in the hands and feet
- affected blood flow to the extremities that can cause gangrene in the fingers or toes
- systemic vasculitis that affects blood flow to the brain or heart that can result in heart attack or stroke
The occurrence of RV is rare, and the complications above are even rarer. However, it’s possible that a rash could be a precursor to something more severe. See your doctor if you experience any signs or symptoms of RV.
The treatment for a rheumatoid arthritis-related rash depends on its cause and severity. A treatment that works well for one type of rash may be useless for another. Treatment usually focuses on managing pain and discomfort, and preventing an infection. It’s also important that treatments target the underlying condition, since rashes may be a sign that your rheumatoid arthritis isn’t well-controlled.
Common over-the-counter (OTC) medications that may reduce the pain of a rash include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). There are several types of NSAIDs, such as ibuprofen (Advil, Motrin IB, Nutrin), naproxen sodium (Aleve), and aspirin (Bayer, Bufferin, St. Joseph).
If your pain is severe, your doctor may also consider prescription NSAIDs. Opioid pain drugs are usually only prescribed for very severe pain since they have a high risk of addiction.
Your physician may also prescribe corticosteroids to reduce the inflammation of your rash, which may in turn reduce painful symptoms. However, these drugs aren’t recommended for long-term use. If your doctor is concerned that your rash could get infected, they’re likely to prescribe either a topical or oral antibiotic, or both.
When it comes to treating the underlying condition, there are several different medication options available:
- Disease-modifying antirheutmatic drugs (DMARDs) decrease inflammation and can slow the progression of rheumatoid arthritis.
- Biologics may be prescribed when DMARDs aren’t enough to manage your symptoms. These injectable drugs target specific immune cells to reduce inflammation, and aren’t recommended for anyone with a compromised immune system.
- Janus-associated kinase inhibitors are the next line of treatment when DMARDs and biologics aren’t working. These drugs help prevent inflammation by affecting genes and immune cell activity.
- Immunosuppressants treat rheumatoid arthritis by reducing the immune responses that damage your joints. However, since they compromise your immune system, they also raise your risk for illnesses and infections.
There are specific treatments for different types of rheumatoid arthritis rashes. For rheumatoid vasculitis, treatment usually starts with corticosteroids, such as prednisone. DMARDs, like methotrexate, may be prescribed to treat the underlying condition.
Treatments for interstitial granulomatous dermatitis include topical steroids and antibiotics. Doctors may also prescribe etanercept (Enbrel), a medication that’s also used to treat psoriasis and psoriatic arthritis.
Palmar edema doesn’t cause any other severe symptoms, so doctors don’t usually prescribe treatments. However, sometimes the rash is the result of a change in medications. You should tell your doctor if you have symptoms after changing medications. But you shouldn’t stop taking your medications unless instructed by your doctor.
There are no permanent solutions that can completely prevent rheumatoid arthritis rashes from occurring. Doctors may try a combination of medications to help you manage your condition. These treatments may reduce inflammation and minimize joint damage.
It’s important that people with RA take measures to live as healthy a lifestyle as possible. Examples of healthy lifestyle practices that may benefit a person with rheumatoid arthritis include:
- Getting plenty of rest, which can help to reduce fatigue symptoms and minimize joint inflammation.
- Exercising whenever possible, which can help to enhance joint mobility and build strong, flexible muscles.
- Taking measures to cope with stress, such as meditation, reading, taking a walk, or doing other activities to promote relaxation.
- Eating a healthy diet full of fruits, vegetables, whole grains, and lean proteins. This can help you maintain a healthy weight, which is important in supporting healthy joints.