Hives, Rashes, and Other Skin Problems in Rheumatoid Arthritis

Rheumatoid arthritis (RA) can cause a rash, hives, or other skin problems like firm lumps called rheumatoid nodules. The severity of skin involvement indicates how severe the disease is. In addition, the medications that treat RA may also affect the skin.

It is very important to bring skin issues to your healthcare provider's attention as they are signs that rheumatoid arthritis symptoms are not well-managed.

This article looks at some of the skin problems associated with rheumatoid arthritis, including those that can arise because of the medications you take for your RA. It also reviews possible treatments.

Medication-Related Skin Issues

Some medications that treat RA can cause skin problems such as:

• Rashes
• Hives
• Thinning skin
• Bruising
• Sensitivity to sunlight

Sometimes, RA medication can also cause problems with blood clotting.

DMARDs and nonsteroidal anti-inflammatory drugs (NSAIDs) may cause rashes and hives. This is generally an allergic reaction and should be brought to the attention of your healthcare provider.

NSAIDs and DMARDs may also cause sun sensitivity. When taking these medications, it is a good idea to avoid direct sunlight and tanning beds and use sunscreen when outdoors.

Aspirin and corticosteroids are known for interfering with blood clotting. They may also thin out the skin and cause bruising. 

Hives (Unrelated to Medication Use)

Some people with RA experience recurrent hives on their skin. These look like rashes with red itchy bumps and are similar to, but independent of, what is experienced as a medication side effect.

This photo contains content that some people may find graphic or disturbing.

See Photo

Rheumatoid Nodules

Subcutaneous nodules are hard lumps of tissue that form under the skin of bony areas, including:

• Elbows
• Ankles
• Fingers

They can even form on the organs, especially the lungs. They range from about the size of a pea to the size of a golf ball.

Rheumatoid nodules affect up to 30% of people with RA.

Small nodules usually do not need treatment. Treatment for large nodules includes disease-modifying anti-rheumatic drugs (DMARDs) or corticosteroid shots to help reduce their size.

Some people may need surgery to remove nodules that become extremely large, painful, and/or infected. 

Vasculitis

Rheumatoid vasculitis (RV) causes inflammation in the vessels that supply blood to the fingers and toes, causing redness and sores on the tips of the fingers and toes and pitting around the nails.

RV can also affect larger blood vessels, causing rashes in larger areas, such as the legs. Skin ulcers (crater-like open sores) may also form and become infected.

In the most serious cases, RV can even cause digital ischemia, which is when your fingers and toes aren't getting enough blood oxygen. It can also damage and destroy the skin and underlying tissues.

Rheumatoid vasculitis occurs in around 2% to 5% of people with RA. This complication is more common in people who have had severe rheumatoid arthritis for a long period of time. 

Treatment of RV is dependent on its severity. Prednisone is a first-line option. Controlling RA, generally, is the best way to manage RV. If RV has caused ulcers and affected organs, cyclophosphamide, a chemotherapy agent, is considered treatment.

The good news is that RV prevalence has declined due to better treatment options and reduced incidences of RA progression.

This photo contains content that some people may find graphic or disturbing.

See Photo

Livedo Reticularis

Livedo reticularis causes spasms in blood vessels that cause a net-like purplish appearance on the skin. Livedo reticularis may cause ulcers, nodules, and discoloration.

This condition is not generally associated with RA, although some research indicates it is common in people with rheumatoid vasculitis. 

Livedo reticularis rashes tend to be harmless and are more common in colder weather.

Treatment of Skin Issues

Some skin issues may require treatment, while others might not. The options that will be considered depend on the cause and severity of your issue.

The goal of treatment is to:

• Reduce pain and discomfort
• Reduce inflammation
• Prevent infection

Common over-the-counter (OTC) medications, including Tylenol (acetaminophen), can help with pain. NSAIDs, including Advil (ibuprofen), can help control and reduce inflammation. 

Severe pain may need prescription NSAIDs.

Corticosteroids can also help reduce skin inflammation, but these medications cannot be used in the long term.

If there is a possibility of infection, a topical or oral antibiotic may be prescribed.

Hives are usually treated with antihistamines.

If medications are the cause of RA skin symptoms, medication replacement or reduction may help prevent or reduce skin symptoms. 

Summary

Rheumatoid arthritis can sometimes cause skin problems. The most common RA-related skin condition is rheumatoid nodules. Some other skin conditions people with RA may experience include vasculitis, hives, and livedo reticularis. 

The medication you take to treat your RA may also cause rashes and hives. When this happens, it may indicate an allergic reaction, so be sure to consult your healthcare provider.