What Is Peripheral Neuropathy
RA can hurt your peripheral nerves, which are part of the peripheral nervous system. Thatâs the communication system that helps your central nervous system send and receive information throughout your body. Most often this damage happens in your hands and feet. Usually this condition, called peripheral neuropathy, results from your nerves being compressed in RA. This can happen because of an inflamed joint , an inflamed tendon , or partial dislocation of a joint. Very rarely itâs caused by rheumatoid nodules, which are lumps or masses under the skin.
Not everyone who has peripheral neuropathy has RA, though. There are other much more common causes. More than half the people who have diabetes get it. Other causes include injuries, infections, and exposure to toxins.
How Ra Drugs May Affect The Nervous System
Common drugs used to treat RA may affect the nervous system. For example, steroid treatment can be linked to impaired thinking, hypomania , and depression. Methotrexate, a disease-modifying anti-rheumatic drug , may cause headaches or problems with concentration.7-10
Some DMARDs, such as sulfasalazine or leflunomide, may lead to peripheral neuropathy . TNF-inhibitors, which may be known as biologic drugs, are known to lead to demyelinating disorders, such as multiple sclerosis or Guillain-Barré syndrome. These can result in life-threatening paralysis. Though these conditions may be possible, they are rare.7-10
Circulation And Nerve Problems In The Lower Limb:
Some people with RA can experience decreased blood supply to feet and legs associated with atherosclerosis which can lead to cramp-like pains in your calf, thigh or buttock muscles when walking and other circulation related disorders such as Raynauds phenomena where the small blood vessels in the skin of the hands and feet shut down in response to changes in temperature leading to the following colour changes: toes/fingers go white, then blue and then red. These colour changes may also be accompanied by a tingling sensation in the affected areas. In rare cases people with RA can develop a skin rash, that may ulcerate, known as vasculitis an inflammation of the blood vessels. This is usually associated with long term disease, and the risks of it occurring are increased by smoking.Some people may experience problems with the nerve supply to their feet known as Peripheral Neuropathy . This may mean that they cannot feel pain or other sensations such as temperature and pressure, or they may experience pins and needles in certain parts of their feet as a result of a trapped nerve.The above are types of problems that are less common, and hopefully, you may never experience them, but you should be aware of the symptoms if they arise and inform your rheumatology Health Care Practitioner responsible for monitoring your rheumatoid arthritis.
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How Do You Treat Peripheral Neuropathy
We help our patients manage pain by first identifying the underlying cause of the pain and designing treatment strategies that target the issue as well as the symptoms.
In the case of peripheral neuropathy, for instance, we may encourage tighter control of diabetes, rheumatoid arthritis, etc., via dietary changes, physical therapy, and other measures designed to effectively treat autoimmune disease.
For pain caused by damaged peripheral nerves, we may recommend:
- Epidural steroid injections
- Spinal cord stimulation
- Dorsal root ganglion stimulation therapy
Dr. Michels notes his overriding goal as a physician is to provide treatments that relieve your pain and enable you to live an active and rewarding life. If youre struggling with pain and other symptoms related to peripheral neuropathy, schedule a visit with Dr. Michels today. Call our Dallas, Texas, office or request an appointment online.
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Treatments And Management Of Numbness And Tingling
Regular physical activity and stretching can help improve joint mobility, increase flexibility, and decrease nerve compression to help treat numbness and tingling.
Specific muscles to focus on stretching to relieve muscle tightness and potential nerve compression include:
- Upper trapezius: The back of your neck to your shoulders
- Levator scapulae: The back and side of your neck
- Abnormal heart rhythms
Early diagnosis can prevent serious complications. Call your healthcare provider immediately if you notice any of these symptoms.
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Neuropathies Associated With Ra
The most commonly seen neuropathies associated with RD are carpal tunnel syndrome in the hands, tarsal tunnel syndrome in the foot, ulnar nerve entrapment , and small-fiber neuropathy. And while its rare, patients who take leflunomide, a DMARD, or one of the TNF-blocking biologic DMARDs, may be at risk for medication-induced neuropathies.
Joint Pain And Stiffness
Typically, your wrists, feet, and knuckles are most commonly affected. Some people show symptoms in their ankles, knees, elbows, and shoulders.
Joints become stiff, particularly in the morning or after long periods of rest. Joints are often described as tender or achy, and their range of motion can be limited.
Along with pain and stiffness, joints affected by RA are often warm to the touch. They also become swollen.
Over time, the long-term damage to the joints can cause severe deformities if inflammation isnt controlled.
Rheumatoid nodules are lumps of swollen tissue just below the skin. These nodules can range from the size of a pea to the size of a grape.
Theyre usually found in places that receive pressure, like elbows from resting on a table.
Nodules generally arent dangerous, but they can be uncomfortable. In rare cases, they can be found in the eye, lungs, or other major organs and may require surgical removal.
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Myrateam Members On Peripheral Neuropathy In Ra
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. Ive heard it compared to shingles pain. Another member shared, I have no feeling in my ring finger and pinky on both hands. Its 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. Its a bit difficult to walk some days, and I keep changing shoes throughout the day, which helps a bit.
Can Numbness And Tingling Be Symptoms Of Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory, autoimmune disease that mainly affects the joints. In some cases, joint inflammation from rheumatoid arthritis can spread to surrounding nerves, leading to nerve damage, numbness, and tingling sensations.
Symptoms like numbness and tingling shouldn’t be ignored as these are signs of a disease complication or that your rheumatoid arthritis is worsening.
This article discusses the connection between rheumatoid arthritis and numbness and tingling and how to find relief.
Peter Dazeley / Getty Images
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How Does It Start
The early symptoms of RA can be easy to miss, may be easy to ignore, or may appear to be symptoms of another disorder.
Symptoms like fever, fatigue, and morning stiffness may be mistaken for the flu, while joint pain and swelling could be mistaken as symptoms of overuse or injury.
Joint problems caused by RA are often mirrored, meaning the same joint is affected on both sides of the body. This mirroring can help make RA more recognizable.
Still, this mirroring may not be present during the early stages of the disease.
Immunosuppressive Therapies For Vasculitic Diseases
The conditions described above illustrate the broad range of vasculitic diseases that have neurological manifestations. Immunosuppressive therapy is the main form of treatment, and the more widely used agents have been described where specific conditions are mentioned. However, newer agents such as mycophenolate mofetil, rituximab and tumour necrosis factor alpha inhibitors are being used to treat SLE, Takayasu’s arteritis, Churg-Strauss syndrome, ANCA-positive vasculitis and Behçet’s disease.
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How Common Is Ra Neuropathy
Overall, 4-5 in 10 people with RA will develop some type of peripheral neuropathy. The most common type is compressive neuropathy, in particular carpal tunnel syndrome. This condition, where nerves in the wrist are squeezed too tightly, affects around 10% of people with RA. Tarsal tunnel syndrome, seen in the toes and feet, probably affects a similar proportion, though symptoms can be mild and overlooked. Less common types of compressive neuropathy affect a nerve at the elbow or another nerve at the elbow or wrist.
What Are Autoimmune Diseases And How Do They Affect Nerves
Autoimmune diseases occur when your immune system mistakenly attacks and destroys healthy tissue in your body. Some of these diseases, such as multiple sclerosis, attack nerve tissue directly.
Others cause a cascading effect that damages nerves. Type 1 diabetes, for instance, destroys your pancreass ability to produce insulin. This makes it impossible for your body to process blood glucose normally. Over time, high blood sugar damages nerves directly and injures the blood vessels that carry oxygen and other vital nutrients to your peripheral nerves.
Symptoms of peripheral neuropathy may include:
- Numbness or tingling in your feet, hands, legs, or arms
- Pain thats sharp, electrical, and/or burning and may be intermittent or become constant
- Lack of sensation in the affected area
- Extreme sensitivity to even light touch, such as covering your feet with a blanket
- Pain with typically non painful activity, such as planting your feet on the floor to stand
- Sensation of wearing gloves or socks when you arent
- Muscle weakness
- Problems with coordination
These symptoms commonly begin in the feet and hands and then spread upward into the arms or legs as the nerve damage progresses.
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The Foot And Rheumatoid Arthritis
For some people, the foot is the first area of the body to present with signs and symptoms of RA. For others, it may be months, years or they may never experience any foot problems at all. There are many ways that RA can affect the feet.
Rheumatoid arthritis is the commonest type of inflammatory arthritis. Up to 90% of people with this condition will report associated foot problems. For some people, the foot is the first area of the body to present with signs and symptoms of RA. For others, it may be months, years or they may never experience any foot problems at all.
Numbness Or Tingling In The Hands Or Feet
A nerve that is damaged or pinched can cause numbness or tingling. The most common ways rheumatoid arthritis causes damaged or pinched nerves include inflammatory joint swelling and rheumatoid vasculitis.2
- Inflammation and swelling caused by RA may put pressure on a nerve. For example, swelling in the wrist can put pressure on the median nerve, causing carpal tunnel syndrome and leading to weakness, numbness, and/or tingling in the thumb, index, and middle fingers.
- Vasculitis,3,4 or inflammation of blood vessels, may reduce blood flow to the feet or another part of the body. The decreased blood flow can cause tingling, numbness, and other symptoms, such as muscle weakness.
Tingling and numbness are symptoms that must not be ignored. Early treatment is the best way to reduce these symptoms and prevent them from getting worse or becoming chronic.
People with RA may have other signs and symptoms that are not directly caused by RA. Instead, these signs and symptoms are related to medical conditions that are associated with RA, ranging from heart problems and chronic kidney disease to Sjogrens syndrome and skin infections.
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The 5 False Facts Your Doctor Mistakenly Promotes Can Rheumatoid Arthritis Cause Neuropathy
The medical community is largely responsible for this misinformation being passed on to the suffering patient. In my view it is the job and responsibility of the family doctor to teach the patient about their neuropathy problem. It is also the doctors job to train the patient in what they can do to improve and manage their neuropathy case successfully.
===> How To End Peripheral Neuropathy < < <
Many neuropathy patients, suffering with foot or hand pain, tingling, numbness, burning, and other evasive and hard to describe neuropathy symptoms, dont even know the name of their condition! And while others do, that is essentially all they know. With this in mind I want to address some of the most commonly INCORRECT facts that suffering neuropathy patients have been told, or come to understand, due to the lack of patient education by the medical community.
1. Neuropathy comes with age, and there is nothing you can do about it.This statement is only partially correct, inasmuch as aging can contribute to the increased onset and intensity of the neuropathy condition. There are however, many simple techniques and procedures that any person can learn which will offset many of these effects of aging as they relate to peripheral neuropathy.
4. Neuropathy just gets worse with time, and you have to accept that you are stuck with it.
Heart And Lung Problems
Many people dont realize that chest pain and shortness of breath can be symptoms of RA. In fact, heart and lung problems can be serious complications of the disease.
People with RA have an increased incidence of blocked and hardened arteries, which could lead to heart attack or stroke, especially if they also smoke.
Pericarditis, or inflammation of the sac that surrounds the heart, is also more common in people with RA. Chronic inflammation can also damage lung tissues, resulting in reduced lung function.
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The 5 False Facts Your Doctor Mistakenly Promotes Can Rheumatoid Arthritis Cause Peripheral Neuropathy
The medical community is largely responsible for this misinformation being passed on to the suffering patient. In my view it is the job and responsibility of the family doctor to teach the patient about their neuropathy problem. It is also the doctors job to train the patient in what they can do to improve and manage their neuropathy case successfully.
===> How To End Peripheral Neuropathy < < <
Many neuropathy patients, suffering with foot or hand pain, tingling, numbness, burning, and other evasive and hard to describe neuropathy symptoms, dont even know the name of their condition! And while others do, that is essentially all they know. With this in mind I want to address some of the most commonly INCORRECT facts that suffering neuropathy patients have been told, or come to understand, due to the lack of patient education by the medical community.
1. Neuropathy comes with age, and there is nothing you can do about it.This statement is only partially correct, inasmuch as aging can contribute to the increased onset and intensity of the neuropathy condition. There are however, many simple techniques and procedures that any person can learn which will offset many of these effects of aging as they relate to peripheral neuropathy.
4. Neuropathy just gets worse with time, and you have to accept that you are stuck with it.
Rheumatoid Nodules Affect Joint Function Or Press On A Nerve
Experts estimate about 35% of people with RA develop rheumatoid nodules at some point.1 Nodules are solid, firm, round lumps of inflamed tissue. Ninety-nine percent of nodules form just below the skin at pressure points near joints, particularly at the elbows, fingers, and feet.
Nodules tend to be between 2 and 5 cm in diameter.1 Over time, nodules may get bigger or smaller, or go away completely. While most nodules are harmless, treatment may be required if a nodule:
- Prevents a joint from working normally. Such a nodule may cause pain and/or affect body mechanics, leading to other joint problems.
- Presses on a nerve, leading to neuropathy. Neuropathy can cause many sensations, most typically numbness, tingling, burning, or shooting pain.
Treatment will also be recommended if a nodule breaks through the skin, causing a lesion that may not heal well on its own or become infected. Medical treatment may include a steroid injection into the nodule and/or a change in medications. Occasionally, surgery to remove the nodule is recommended.
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What Are Symptoms To Look Out For
Neuropathy can feel like burning or tingling, and sometimes also feel like stabbing pain. Sometimes it can also cause weakness and numbness. It can start gradually, moving up from your feet or hands toward your legs or arms. Some people describe it as feeling like youâre wearing gloves or socks even when you arenât. Symptoms can get better with treatment. The specific symptoms depend on which nerves are affected, such as:
- Sensory nerves in the skin that make you feel temperature, pain, or touch
- Motor nerves that control your muscles
- Autonomic nerves that control your bodyâs basic functions, such as blood pressure, heart rate, and digestion
When Should I Seek Emergency Care For Numbness And Tingling
Numbness and tingling in the extremities can be signs of more serious conditions, such as a stroke or heart attack. Seek emergency care if your numbness and tingling occurs suddenly or is accompanied by weakness, slurred speech, dizziness, chest pains, blurry vision, abnormal heart rhythms, or serious headache.
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