Rheumatoid Arthritis Rashes: 5 Types of Skin Irritations Associated With RA

It's not just a joint disease. Here's what to look for.

Photo: Getty Images

Many people equate rheumatoid arthritis (RA) with joint pain—and that makes sense, since this inflammatory disease attacks healthy tissue in the joints, leading to swelling and reduced mobility. But the systemic effects of RA aren't limited to the joints. Your skin may be susceptible too.

Skin rashes are more often associated with psoriatic arthritis, but people with RA can develop rashes as well. One type of rash, in particular, can pop up on your extremities: it's called rheumatoid vasculitis, and it's a warning sign about the overall status of your RA.

"It's not common, but we do see rheumatoid vasculitis in patients with uncontrolled RA," says Juan J. Maya, MD, of the Rheumatology Center of Palm Beach and medical advisor to the digital community CreakyJoints. "Luckily, by treating RA, you can control rheumatoid vasculitis."

How do you know if you have rheumatoid vasculitis, and what can you do about it? Here's everything you need to know about this RA-related rash (as well as a few others you might experience).

What is rheumatoid vasculitis (RV)?

Rheumatoid vasculitis is a rare but serious symptom of uncontrolled or poorly managed RA, says Robert Koval, MD, a rheumatologist at Texas Orthopedics. It causes nerve inflammation, joint pain and swelling, and blotchy red lesions on the extremities, especially the legs and hands.

It can sometimes affect your internal organs as well, so while it's unlikely you'll experience rheumatoid vasculitis if you have RA, if you do, you need to see your doctor right away. Rare cases can cause heart attack, stroke, or kidney failure, per the Vasculitis Foundation.

What does rheumatoid vasculitis look like?

With its reddened, splotchy appearance on the extremities, especially the legs and hands, rheumatoid vasculitis is hard to miss.

"Visually, I can recognize it right away," says Dr. Koval. "It's an impressive rash with a sudden onset and can be scary looking."

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Courtesy of DermNet NZ
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Courtesy of DermNet NZ

What are the symptoms of rheumatoid vasculitis?

In addition to a telltale rash, people with RV may also feel generally unwell (think fever and fatigue), per Cedars-Sinai. They may experience weight loss, or may have any of the following symptoms:

  • sores or ulcers on the skin
  • bruising
  • digital ischemia (loss of tissue due to decreased circulation)
  • scleritis of the eye, causing inflammation, pain, and redness
  • muscle weakness or tingling

What causes rheumatoid vasculitis?

According to Dr. Maya, rheumatoid vasculitis is an immune reaction that has to do with the heightened autoimmune state related to RA. Beyond that, experts still don't know exactly what causes it; it's most likely a combination of uncontrolled RA, genetic predisposition, and concurrent issues such as infection or smoking.

The Vasculitis Foundation suggests that higher levels of certain antibodies and proteins often found in the blood of people with RA may contribute to the risk.

How is rheumatoid vasculitis treated?

If a diagnosis of rheumatoid vasculitis is confirmed, your doctor will start by treating the rash with anti-inflammatory ointments or creams, as well as antibiotics, if necessary. It may also be necessary to take OTC anti-inflammatories, like ibuprofen, and steroids (either orally or topically) to get the rash under control.

Next, you and your doctor will have to discuss how to better manage your RA, since these types of rashes are most common in advanced cases.

"If your disease is flaring up, we would talk about adding a short course of a steroid or advancing [your RA] therapy to an immunosuppressant," Dr. Koval explains.

If the cause is unclear, your doctor may perform a rash biopsy to confirm the diagnosis. In the meantime, taking care of your RA by getting enough rest, exercising, and eating well can go a long way toward improving your overall condition.

Other RA rashes

Livedo reticularis. Like with most RA-related rashes, livedo reticularis is caused by inflammation (specifically, in this case, of the blood vessels). It may look red or purple, is commonly seen on the extremities, and may be brought on by colder temperatures. This benign rash develops in a lacy pattern, says Dr. Koval.

Medication rashes. People with RA are often on several different medications. Any one of them may cause a rash depending on a person's allergic response, explains Dr. Maya.

According to the National Library of Medicine, skin rash is a potential side effect of some oral medications that people with RA might take, including:

  • methotrexate
  • hydroxychloroquine
  • celecoxib
  • diclofenac
  • tolmetin
  • ibuprofen/naproxen

Additionally, injections can cause rashes locally at the injection site, and medications like prednisone can cause your skin to thin, which can leave it more susceptible to bruising and tearing, says CreakyJoints.

Hives and eczema. The exact way these skin conditions are connected to RA isn't confirmed, but it's fairly widely accepted that they often go hand in hand. Researchers writing in Autoimmune Disease of the Skin cite "increasing evidence" that up to half of all unexplained cases of chronic hives may be due to an underlying autoimmune condition. Likewise, a 2021 review and meta-analysis in Allergy, Asthma & Clinical Immunology finds that people with eczema (aka atopic dermatitis) are at higher risk of autoimmune disease, including rheumatoid arthritis.

Rheumatoid neutrophilic dermatitis. This rare skin manifestation of RA can produce red bumps, nodules, plaques, or itchy skin patches, per a 2019 report in the journal Reumatologia. It occurs more commonly in people with severe arthritis, researchers note. Another case report in the Australasian Journal of Dermatology describes a woman who developed blisters on her lower extremities.

Regardless of what your symptoms are or what kind of rash you think you have, you shouldn't ignore it, says Dr. Koval: "Any rash in RA should prompt a patient to seek medical attention."

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