Rheumatoid Arthritis Rash
People with rheumatoid arthritis (RA) must take steps to live a healthy lifestyle and take utmost care of their skin.

Rheumatoid arthritis (RA) is an autoimmune disease that causes joint swelling and inflammation and may affect the skin. Skin problems can occur in people with severe RA although it may also be seen in the early stages of RA.

Symptoms of a rheumatoid arthritis rash

Common symptoms of rheumatoid arthritis (RA) rash include:

  • Red patches that vary in size
  • On darker skin tones, patches may appear burgundy with a red-violet hue. They may appear as multiple pinpoint dots.
  • Swelling
  • Itchiness
  • Usually develops on the fingertips, toes, and elbows although it can occur anywhere on the body and sometimes can be painful
  • Rarely, they may look like deep red pinpricks
  • When an RA rash becomes advanced, ulcers or lesions may develop
  • The rash site may develop thin, wrinkly skin that is fragile and prone to bruises
  • Skin with a rash may become pale, translucent, and dry
  • Can cause redness on the palms and the back of the hands 
  • Nail changes are common 

Although it is unusual and only occurs in severe circumstances, these rashes can cause painful ulcers. Once the ulcers are present, they can occasionally get infected and cause further problems and difficulties during the treatment and healing process.

What are the known skin complications that people with rheumatoid arthritis may develop?

Rheumatoid arthritis (RA) symptoms can change depending on how severe the condition is. 

Although skin complications are uncommon, they are regarded as severe if any of the following skin conditions manifest in people with RA:

  • Rheumatoid vasculitis 
    • An uncommon RA complication
    • Occurs when blood vessels are swollen
    • Can result in a variety of symptoms ranging from a red, itchy rash to a skin ulcer caused by a lack of blood flow 
    • Frequently seen on the legs and can be painful. Fortunately, only a small percentage of cases progress to vasculitis.
  • Palmar erythema
    • Reddened palms, also known as palmar erythema, are one of the most prominent general rashes in people with RA
    • According to one research, over 60 percent of those with RA exhibit palmar erythema at some stage
    • Generally affects both hands and is neither unpleasant nor irritating
    • Your hands may feel somewhat warmer than usual
  • Interstitial granulomatous dermatitis or rheumatoid papules
    • Characterized by red plaques or pimples that closely mimic eczema
    • The rash is irritating and even painful but is extremely uncommon and rare
    • Patches may change in size or shape over several days or months
    • Symptoms may be seen on the chest, abdomen, or back; it can also affect the limbs
  • Livedo reticularis
    • A rash that is not usually associated with RA. Some experts, on the other hand, feel it is a symptom of RA.
    • May cause skin discoloration. It is generally purple with a lace or net-like design on the legs.
    • Not dangerous if left untreated. It does not cause any further symptoms. However, treatment is needed if it is associated with another medical disease, such as RA.
  • Hives
    • People with RA often have cutaneous hives. With the bump, the skin appears red and itchy, and the rashes appear independently, similar to treatment and side effects.
    • On light skin tones, hives might appear pink or red
    • On medium to dark skin tones, the skin seems irritated and inflamed; however, erythema (skin reddening) is not necessarily as noticeable
    • Hives cause skin welts that are frequently the same color as the skin but slightly lighter or darker
    • Hives are increasingly being recognized as a symptom of RA by allergists and doctors
  • Rheumatoid neutrophilic dermatitis (RND)
    • People with RA occasionally experience RND, a skin condition characterized by a raised red, blue, or purple rash that covers the arms and legs, which is the typical first sign
    • Usually involves a single limb or torso. Neutrophil dermatitis can result in painful skin blisters.
  • Raynaud’s phenomenon
    • The blood vessels that supply blood to your fingers and toes constrict during Raynaud's phenomenon
    • Stress or cold weather may be a cause
    • The skin may turn white or blue, become uncomfortable or turn numb
    • Sores and ulcers may take a while to heal during this condition
  • Rheumatoid nodules
    • Approximately 50 percent of people with RA develop rheumatoid nodules, which are tissue lumps that form under the skin
    • Frequently develop over bony regions, such as your fingers or elbows
  • Atopic dermatitis (eczema)
    • A typical skin condition characterized by a rash that is red, purple, or extremely itchy
    • Although RA can cause eczema, one study reported that people with atopic dermatitis had rates of RA that were 72 percent higher than those in the general population. The existence of autoimmune diseases in some eczema types is a research topic.
  • Sweet's syndrome and pyoderma gangrenosum
    • A painful, blistering rash with mucosal lesions is a symptom of Sweet's syndrome
    • An ulcerative skin rash with bluish borders, the emergence of fresh ulcers, and minimal skin damage are all symptoms of pyoderma gangrenosum 
    • Pyoderma gangrenosum often starts as tiny red bumps that quickly (sometimes in just a few days) develop into uncomfortable open sore
    • This extremely uncommon condition usually affects the skin on the lower legs
    • It is a serious condition that calls for medical attention from your doctor
    • If you notice any of these symptoms, make an immediate appointment with your doctor

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

What are the treatment options for a rheumatoid arthritis rash?

A complete treatment strategy blends nonpharmacologic interventions, pharmaceutical modalities, and surgery. Regulating inflammation is essential for delaying or avoiding disease development while also controlling symptoms; ideally, a rheumatologist may help you decide the best course of treatment depending on your signs and symptoms.

Nonpharmacologic measures

  • Regular rest
  • Nutritious diet
  • Occupational therapy
  • Exercises
  • Paraffin baths to warm the digits

Pharmacologic therapy

  • Disease-modifying antirheumatic drugs (DMARDs)
    • Prescribed to practically all those who have rheumatoid arthritis (RA) because they appear to halt disease progression
    • Because the ultimate objective is to avoid erosions and increase deformity, DMARDs should be administered within three months after diagnosis
  • Biologic agents
    • May be beneficial when DMARDs fail to provide a therapeutic response
    • Often administered in conjugation with DMARDs
    • Target specific immune cells to reduce inflammation and aren’t recommended for anyone with a compromised immune system
  • Janus-associated kinase inhibitors
    • When DMARDs and biologics fail, they are the next line of treatment
    • Reduce inflammation by influencing genes and immune cell activity
  • Immunosuppressants 
    • Reduce the immune responses that damage your joints to treat RA
    • However, they weaken your immune system and put you at risk of illnesses and infections
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Because of their anti-inflammatory and analgesic effects, these medications are used as supplementary therapy in the early stages of the illness and as needed, with or without corticosteroids
    • Your doctor might also recommend NSAIDs on a prescription if your pain is severe. Because opioid painkillers have a high risk of addiction, they are typically only prescribed for extremely severe pain
  • Corticosteroids
    • These are used as adjunctive therapy in the early stages of the disease for symptoms that are not sufficiently controlled by DMARDs, either with or without NSAIDs
    • Additionally, your doctor might advise corticosteroids to lessen the swelling of your rash, which could ease your discomfort
    • However, prolonged use of these medications is not advised
  • Antibiotics
    • Your doctor may recommend either a topical, oral, or both antibiotics if they are concerned that your rash might become infected

There are no long-term solutions that can completely prevent RA rashes. To help you manage your condition, your doctor may prescribe a combination of medications. These treatments may help reduce inflammation and joint damage. People with RA must take steps to live a healthy lifestyle and take utmost care of their skin.

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Medically Reviewed on 11/4/2022
References
Image Source: iStock image

When Rheumatoid Arthritis Causes Skin Problems: https://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-skin-problems#:

Rheumatoid arthritis and the skin: https://dermnetnz.org/topics/rheumatoid-arthritis-and-the-skin

Rheumatoid Arthritis and Skin Problems: What You Need to Know: https://creakyjoints.org/about-arthritis/rheumatoid-arthritis/ra-and-skin-problems/