In RA, your immune system goes into overdrive and attacks your joints. This creates uncontrolled inflammation that damages the cartilage in your joints and circulates throughout your body. Skin affected by inflammation in RA can develop the following problems.
Rheumatoid Nodules
Rheumatoid nodules form when ongoing inflammation from rheumatoid arthritis damages tissue in one spot, usually near joints or pressure points. In response, the body builds a “lump” made of immune cells. At the center is a small area of dead tissue, surrounded by white blood cells that gather there to isolate the damage and prevent it from affecting nearby healthy tissue.
Nodules usually appear over bony areas, including:
- Elbows
- Fingers
- Forearms
- Heels or near the Achilles tendon
- Hips
- Low back (the sacrum)
- Scalp
In many cases, the nodules don’t cause symptoms or bother people from a cosmetic standpoint and can remain untreated, says Dr. Greer. Sometimes they go away on their own.
In other cases, the nodules can be painful and interfere with daily activities. Rarely, a nodule can cause compressive neuropathy, in which a nerve is squeezed by the nodule, causing numbness and tingling.
Symptomatic skin nodules can be treated with injections of a combination of a steroid and a pain reliever into the nodule. If this doesn’t help, or the nodules are causing complications like infections or severe pain, they may have to be surgically removed.
Although it’s less common, nodules can also form in other places in the body, such as the lungs, eyes, and vocal cords.
Easy Bruising
RA can lead to a low platelet count, which can cause bruising of the skin and bleeding from the gums. Platelets are cells that help the blood clot in response to an injury.
Low platelet levels can also be caused by some arthritis medications. “If a person [with RA] has bruising all over their body, it could be due to a medicine causing low platelets or the disease itself,” Greer says.
People with RA who experience bruising or bleeding should talk to their provider so that the risks can be properly managed.
Palmar Erythema
Rheumatoid Vasculitis
Rheumatoid vasculitis is a rare condition that occurs in less than 1 percent of people with RA.
Rheumatoid vasculitis occurs when inflammation of the small blood vessels in the skin causes the vessel walls to weaken. When blood vessels in the skin are damaged, they can’t deliver enough oxygen and nutrients to the tissue. That causes the skin to break down, leading to painful ulcers, especially on the lower legs or fingertips.
“Vasculitis can look different in different people,” says Greer. “The rash can appear as purplish spots or little pinpoints of red on the skin, and it can be itchy.
Typically, people who have rheumatoid vasculitis have very active disease that is not well-controlled, says Greer. It’s also most common in people who have had RA for many years, though in rare cases it can happen sooner.
Because vasculitis is a serious complication, it requires careful management, often with a combination of medications that includes steroids, immunosuppressants or biologics, angiotensin-converting enzyme (ACE) inhibitors, and in some cases, surgery.
Neutrophilic Dermatoses
Neutrophilic dermatoses are a group of skin conditions that occur as a result of white blood cells (called neutrophils) that flood the skin because of the body’s chronic inflammation. Symptoms of these conditions include purple nodules, papules, or plaques that can be painful.
The two most common forms of neutrophilic dermatoses that may develop in people with RA include:
- Sweet syndrome: This causes sudden, tender skin lesions, usually in the upper part of the body, and often comes with a fever. This rash may enlarge to form plaques or blisters. It can be painful and burning, but is not itchy.
- Pyoderma gangrenosum: This is a very serious and painful manifestation in which the skin develops ulcers, usually on the legs. If not treated promptly, the ulcers can become infected or progress to the point where underlying tendons or muscles are exposed.
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