How Rheumatoid Arthritis Can Affect Skin

At The Pain Center of United States, the pain specialists know that, while rheumatoid arthritis is known as a condition that affects the joints, unfortunately, it can also affect the skin. The disease itself and medications taken for RA can wreak havoc on a patient’s skin, causing many problems that range from sun sensitivity, to rash, and firm lumps of tissue called nodules. Let’s take a closer look at some of these problems.

Rash and Ulcers. Approximately one in 100 people with rheumatoid arthritis will find themselves dealing with vasculitis, which involves arteries that carry blood to the skin, nerves, and internal organs. When these small vessels that supply blood to the skin on the fingertips and around the nails come into play, this results in small pits on the patient’s fingertips or small sores or redness around the nail. When larger blood vessels are involved, this can cause a painful rash, often on the legs. In more serious cases, ulcers can form with the risk of infection.

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Rheumatoid Nodules. 20% of people with rheumatoid arthritis can develop rheumatoid nodules. Nodules are hard lumps of tissue, about the size of a pea, that form under the skin over bony areas such as the elbow or ankle (but in some cases, they can also form on internal organs). For certain patients, treatment with disease-modifying anti-rheumatic drugs (DMARDs) used to control RA or injections of corticosteroid medications may help shrink nodules. If rheumatoid nodules become infected or painful, surgery may be necessary to remove them. On rare occasions, nodules can mean the presence of rheumatoid vasculitis.

Side Effects of Medication. Medication can be very helpful in treating RA, but often times patients will experience unwelcome side effects. Certain arthritis drugs are associated with skin rashes. These drugs include the following:

DMARDs such as methotrexate (Rheumatrex, Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), and minocycline (Minocin).

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin), naproxen (Naprosyn), diclofenac (Voltaren), tolmetin (Tolectin), and celecoxib (Celebrex).

But remember that a skin rash can also be a sign of an allergic reaction to a drug. Patients must let their pain management specialist know if their skin breaks out or starts itching. Depending on the type of rash and severity of the rash, the patient’s dosage may be lowered or the medications may be stopped altogether. In some cases, another drug may need to prescribe, such as a corticosteroid or antihistamine, to stop the reaction.

Skin Sensitivity. Some arthritis medications can increase the risk of bruising by thinning the skin or interfering with blood clotting. These medications include aspirin and corticosteroid medications such as prednisone. Some medications can also increase a patient’s sensitivity to sunlight. These include:

DMARDs such as cyclosporine (Sandimmune, Neoral) and methotrexate (Rheumatrex, Trexall)

NSAIDs such as diclofenac (Voltaren), diflunisal (Dolobid), ketoprofen, naproxen (Naprosyn), and piroxicam (Feldene).