Arthritis And Your Skin: 6 Ways Ra Affects Skin Problems
Arthritis is a common disease that affects different joints of the body, often leading to joint pain, stiffness and swelling. One of the most common subtypes of arthritis is rheumatoid arthritis.
Rheumatoid arthritis develops due to autoimmunity, which is a process that causes the immune system which normally functions to protect us foreign pathogens starts to attack healthy tissue. Inflammation is a hallmark of autoimmunity, and high levels of inflammation throughout the body can lead to the development of other diseases that affect different organs including the heart, eyes, blood vessels and even the skin.
What Causes Rheumatoid Nodules
Currently, research doesnt clearly indicate a specific cause of rheumatoid nodules and why exactly they develop in some patients and not in others. Given that they generally form on extensor joints, rheumatoid nodules could be the result of repeated pressure on the affected joints over time. Some patients even report a decrease in size or disappearance over time.
Patients who are bedridden, sometimes form rheumatoid nodules on the backs of their elbows, legs, hips and sacrum. There are even reported cases of these nodules on the posterior scalp. These are all the pressure points of bedridden patients and possibly the catalyst to the formation of rheumatoid nodules.
Ra In The Muscular System
When inflammation makes it harder to move your joints, the attached joints will get weak. According to a 2017 report in the journal EBioMedicine, a 2575% reduction in muscle strength has been observed in people with RA when compared to others without RA of the same ages.
People with RA can develop a condition called rheumatoid myositis that causes weakness, swelling, and pain. While rheumatoid myositis is poorly understood, researchers speculate a number of causes, including inflammation, the medications used to treat RA, impaired joint flexibility, and reduced activity levels.
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Which Patients With Rheumatoid Arthritis Get Vasculitis
Rheumatoid vasculitis most often occurs in people with at least 10 years of severe disease. In general, people who get vasculitis have many joints with pain and swelling, rheumatoid nodules, high concentrations of rheumatoid factor in their blood, and sometimes smoke cigarettes. They may also have an enlarged spleen and chronic low white cell count, a condition known as Felty’s Syndrome.
Fewer than five percent of people with rheumatoid arthritis get skin vasculitis. Fortunately, far fewer people get vasculitis of larger arteries.
There is evidence to support that since the introduction of effective treatments for rheumatoid arthritis, the occurrence of rheumatoid vasculitis is far less common.
Rheumatoid Nodule: Causes And Treatment
Roughly 10 to 40 percent of patients will develop nodules, which can vary in size and are commonly found on the extensor surfaces . Nodules are quite common in rheumatoid arthritis patients, but some factors may increase ones risk of developing them, such as testing positive for rheumatoid factor and smoking. Majority of nodules are asymptomatic, meaning, they do not require treatment, but for nodules that interfere with physical function, injections or surgical removal may be required.
Treatment for rheumatoid nodules is usually the same as for rheumatoid arthritis DMARDs . These medications can help reduce the size of rheumatoid nodules, but if patients take methotrexate , nodules may actually grow in size. Some patients undergo steroid injections, but in cases where nodules become infected surgery may be required to remove them.
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Treatment Of Rheumatoid Vasculitis
Rheumatoid vasculitis is a serious condition and must be treated aggressively because it can lead to serious complications, depending on the location of the vasculitis. For example, for vasculitis directly on joints, ulcers can form that are difficult to heal. In addition, rheumatoid vasculitis can progress and cause nerve damage.
Treatment is dependent on the severity of the rheumatoid vasculitis. Prednisone, a steroid, is often the first-line treatment.
Controlling RA, in general, is also indicated, so medications that treat RA such as methotrexate and tumor necrosis factor inhibitors are prescribed. If rheumatoid vasculitis has progressed to major organs or has caused a skin ulcer, cyclophosphamide, a chemotherapy medication, may be prescribed.
According to Johns Hopkins, the incidence of rheumatoid vasculitis has declined in recent years. It is possible that better treatment options for RA have led to the decline.
Higher Sensitivity To The Sun
People that take certain types of drugs, including medications such as non-steroidal anti-inflammatory drugs , methotrexate, certain types of antibiotics and antidepressants, develop sensitivity to the sun. Another disease in which patients are more sensitive to the sun is the autoimmune disease lupus. Symptoms of photosensitivity include burning in the sun more easily that you previously did, or developing rashes or hives faster than you have previously have. Essentially, if you notice any changes in how, where and the pattern in which you burn in the sun, make sure to make an appointment to see your doctor as that could signal an underlying condition that needs to be treated.
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What Is The Long
Skin involvement alone is usually not very serious. Vasculitis that involves the nerves and internal organs is more difficult to treat and usually occurs in people with very severe rheumatoid arthritis. For all of these reasons, it can potentially impact outcome and requires close medical follow-up.
Last reviewed by a Cleveland Clinic medical professional on 02/28/2019.
References
Who Gets Rheumatoid Arthritis
Rheumatoid arthritis predominantly affects females with an increased risk for those with a first-degree relative affected. The prevalence is estimated to be 1%. Rheumatoid arthritis affects all races. The peak age of onset is 3550 years. Extra-articular involvement develops in approximately 40%, and skin changes in 30%.
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What Is The Outlook For Rheumatoid Arthritis Rashes
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.
Its 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.
What Is Rheumatoid Arthritis
Rheumatoid arthritis is a chronicsystemicinflammatoryautoimmune disease characterised by a symmetric destructive polyarthritis and extra-articularmanifestations including skin changes.
Skin changes of rheumatoid arthritis can be classified as:
- General cutaneous manifestations
- Adverse cutaneous effects of treatment.
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Skin Problems By Condition
We refer to arthritis as an invisible condition because the inflammation and pain associated with the various types of arthritis are difficult to see. But sometimes, symptoms can become more visible especially when they are viable on the skin.
Here are the ways in which RA, PsA, Lupus, Scleroderma, and AOSD may affect your skin.
Carpal tunnel symptoms typically include tingling or numbness, weakness, swollen fingers, electric shocks, fatigue, wrist and arm pain.
Rheumatoid Arthritis
According to the Cleveland Clinic, up to 35 percent of people with RA develop rheumatoid nodules. These are hard pea-size lumps that develop under bony areas, such as the elbows, fingers and ankles, and in rare cases, on the organs .
RA nodules may be indicative of rheumatoid vasculitis , a condition causing inflammation of the small and medium-sized blood vessels. RV is very rare, and research shows it is declining due to the increase of new therapies to treat RA.
RV is still, however, a very serious and life-threatening condition. The blood vessels most commonly affected are those carrying blood to the skin, nerves and internal organs.
Psoriatic Arthritis
Up to 85 percent of people with psoriatic arthritis experience skin symptoms long before they notice any joint symptoms, according to the National Psoriasis Foundation. Red, scaly rashes on the body are common with psoriatic arthritis.
Lupus
Scleroderma
Adult-onset Still’s Disease
Rheumatoid Nodules: Are Rheumatoid Nodules Dangerous
A variety of symptoms can occur when suffering from rheumatoid arthritis. The sporadic, yet chronic nature of the disease is such that symptoms may come and go over time and manifest in different ways.
One of the most common skin-based symptoms of rheumatoid arthritis is the development of nodules. These rheumatoid nodules occur in about one-quarter of rheumatoid arthritis patients, both men and women and their severity can vary from patient to patient. Although nodules are generally not dangerous or debilitating, there are treatment options available if it becomes necessary to have them reduced or removed.
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Stomach Pain Or Indigestion
RA and medicines used to treat it are linked to mouth and stomach ulcers, stomach bleeding, acid reflux, diarrhea, and constipation. Painful diverticulitis and colitis are also possible if you have RA.
RA drugs like NSAIDs often cause ulcers or an upset stomach.
Belly pain is sometimes a sign of a rare RA complication called rheumatoid vasculitis — when inflammation spreads to your blood vessels. Weight loss and lack of appetite are other symptoms. Vasculitis is serious, so see a doctor right away. Learn more about vasculitis symptoms and types.
How Is Rheumatoid Vasculitis Treated
Treatment depends upon the size of the vessel, the organs affected, and the overall severity of the vasculitis. Vasculitis involving the fingertips and skin around the fingernails, or that only causes a rash, is treated with pain control, antibiotic cream, and local protection. Many rheumatoid arthritis patients who experience this kind of vasculitis are not being effectively treated for their joint disease. Drugs that treat rheumatoid arthritis, can be started and often improve both the joint symptoms and the vasculitis.
Because more serious rheumatoid vasculitis is rare, studies comparing an active drug to an inactive material have not been published. Treatment recommendations for vasculitis that causes nerve damage, skin ulcers, and damage to internal organs rely on descriptions of series of patients with vasculitis and your doctor’s previous experience.
When this kind of vasculitis occurs, despite adequate treatment of joint disease, stronger treatments to control the immune system are used. When any of these treatments are used, very careful monitoring by a doctor is necessary.
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What Are The Symptoms Of Rheumatoid Vasculitis
When vasculitis involves the small arteries and veins that nourish the skin of the fingertips and skin around the nails, small pits in the fingertips or small sores causing pain and redness around the nails can occur. Involvement of somewhat larger arteries and veins of the skin can cause a painful red rash that often involves the legs. If the skin is very inflamed, ulcers can occur and infection becomes a complicating risk.
Vasculitis that injures the nerves can cause loss of sensation, numbness and tingling, or potentially weakness or loss of function of the hands and/or feet. The rare vasculitis of larger arteries can cause complete absence of blood flow to tissue sites supplied by the affected vessel , which can cause gangrene of fingers or toes, stomach pain, cough, chest pain, heart attack, and/or a stroke if the brain is involved. This form of systemic vasculitis can also be accompanied by general symptoms such as fever, loss of appetite, weight loss, and loss of energy.
How Rheumatoid Arthritis Affects More Than Joints
Learn more about how the inflammation associated with RA can impact organs and systems beyond the joints.
Arthritis can cause painful, swollen knees or fingers that are impossible to ignore. But other parts of the body, including the skin, eyes and lungs can also be affected. Rheumatoid arthritis is a systemic disease, meaning it can affect many parts of the body.
In addition, the drugs used to treat RA can also cause health problems. Many of these problems such as bone thinning or changes in kidney function cause no immediate symptoms so your doctor may monitor you through lab tests or checkups. For other problems such as skin rashes or dry mouth its important to report any symptoms to your doctor, who can determine the cause, and adjust your treatments accordingly.
Its important to be aware of the affected areas of the body and side effects you may experience. This way, early aggressive treatment can help you avoid RA-related health issues.
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Ra Can Affect Other Organs
When initially diagnosing RA, it is probably a result of you going to your physician, complaining of joint pain. RA most commonly affects the small joints of the body, such as the hands, wrists, and feet, but can affect any joint of the body, even the jaw.
Symptoms in keeping with joint pain include joint stiffness and swelling for six weeks or longer. Morning stiffness occurs, and it lasts at least 30 minutes.
However, RA can also affect other organ systems. For example, you may have noticed fatigue, loss of appetite, and a general feeling of sickness, such as having the flu.
It may also affect larger body systems.
- The skin It may cause lumps under the skin, called rheumatoid nodules. Other skin complications include rheumatoid arthritis bruising, rashes, blisters, and ulcers. Severe skin involvement typically indicates a serious form of RA.
- The lungs and heart it can affect the lining of these organs. Symptoms may not occur, but for shortness of breath or chest pain, it is recommended that you call your physician.
- The lower extremities it may cause decreased sensation, causing numbness and tingling. This is called peripheral neuropathy.
RA can also affect other organ systems.
Identifying A Rheumatoid Arthritis Rash
Rheumatoid arthritis is an autoimmune disease on a very basic level, this means that the body attacks its own cells because it believes them to be invaders.
RA causes symptoms that mostly relate to joint problems. However, sometimes RA flares can cause additional symptoms, including rashes on the body resulting from inflammation.
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What Causes Rheumatoid Vasculitis
The cause of rheumatoid vasculitis is not known. An abnormally active immune system appears to play an important role in blood vessel inflammation. Evidence linking the immune system to vasculitis includes:
- High levels of rheumatoid factor
- The presence of other proteins in the blood
- Lower levels of proteins in the blood , which are used up when inflammation occurs.
- The appearance of inflamed blood vessels under the microscope, which shows immune cells within the wall of the vessel.
Cutaneous Adverse Effects Of Treatment For Rheumatoid Arthritis
The treatment of rheumatoid arthritis can cause side effects involving the skin.
Disease modifying antirheumatic drugs used in the treatment of rheumatoid arthritis include methotrexate, azathioprine, leflunamide, ciclosporin, and hydroxychloroquine. Skin side effects are well documented.
There are many new and emerging treatments for rheumatoid arthritis including biological treatments, Janus kinase inhibitors, rituximab , tocilizumab with their associated cutaneous side effects. Tumour necrosis factor inhibitors are biologic agents used widely for treatment-resistant rheumatoid arthritis. Many cutaneous side effects have been reported with their use in rheumatoid arthritis including psoriasis, dermatitis, leukocytoclastic vasculitis, lichenoid drug eruptions, and non-infectious cutaneous granulomatous reactions, such as disseminatedgranuloma annulare, sarcoidosis-like lesions, and interstitial granulomatous dermatitis.
Dermatological side effects of tumour necrosis factor inhibitors
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Skin Issues With Ra In The Feet
Changes in your foot shape can result in pressure spreading out unevenly across your foot as you walk. Excess pressure can result in skin conditions:
- Bunions are thick, bony bumps that develop in the joint at the base of your big toe or fifth toe.
- Corns are thick, hardened skin patches that may be larger and less sensitive than the rest of your foot skin.
If theyre not treated, both bunions and corns can develop into ulcers. These are open sores that result from skin breaking down due to a lack of circulation or tissue damage in the foot. Ulcers can become infected and cause further foot pain and damage.
What Causes Rheumatoid Arthritis
Rheumatoid arthritis is multifactorial in origin. Although regarded as autoimmune with anti-citrullinated proteinantibodies and rheumatoid factor , genetic and environmental factors are also important in the pathogenesis. In ACPA-positive disease the most significant association is mapped to the HLA-DRB4 gene. ACPA are found in 60% of patients with rheumatoid arthritis .
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Rheumatoid Arthritis And Medication Side Effects
There are medications to specifically treat skin complications in rheumatoid arthritis, such as methotrexate, non-biologic DMARDs and tumor necrosis factor- inhibitors. Unfortunately, although these medications may treat skin complications, they also bring along side effects and other complications. For starters, the use of TNF inhibitors may be associated with the development of psoriasis, along with effects to the injection site, infusion reactions, skin infections, eczema, lupus, vasculitis, lichenoid drug eruptions, and granulomatous reactions.Rheumatoid arthritis patients are also at a higher risk for skin cancer and TNF inhibitors may further increase this risk, but research is still pending on a definite conclusion.
Other side effects of medications include skin rashes, easy bruising, and sun sensitivity. Speak to your doctor about any side effects you may be experiencing while taking medications for rheumatoid arthritis.
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