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Rheumatoid Arthritis Skin Problems

Rheumatoid arthritis (RA) is primarily a disease of the joints. But the disease and many of the medications used to treat it can also affect the skin, causing problems as diverse as sun sensitivity, rash, and firm lumps of tissue called nodules.

Rheumatoid Nodules

About 20% of people with rheumatoid arthritis develop rheumatoid nodules. These hard lumps of tissue, about the size of a pea, may form under the skin over bony areas such as the elbow or ankle. However, they can also form on internal organs.

For some people, 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 reflect the presence of rheumatoid vasculitis, which is inflammation of the small and medium-sized blood vessels.

Skin Rash and Ulcers

Vasculitis occurs in approximately one in 100 people with rheumatoid arthritis. The most commonly involved blood vessels are arteries that carry blood to the skin, nerves, and internal organs.

When the small vessels that supply blood to the skin on the fingertips and around the nails are involved, the result can be small pits on the fingertips or small sores or redness around the nail. Involvement of larger blood vessels can cause a painful rash, often on the legs. In serious cases, ulcers can form with the risk of infection.

Medication Side Effects

Often the skin problems people with RA experience are related to the medications they take to ease symptoms or control their disease. Drug-related skin problems include:

Skin rashes. Arthritis drugs associated with skin rashes 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).

Because a skin rash can be a sign of an allergic reaction to a drug, it is important to let your doctor know if your skin breaks out or starts itching. Depending on the type and severity of the rash, your doctor may lower the dose or have you stop your medication altogether. In some cases, your doctor may need to prescribe another drug, such as a corticosteroid or antihistamine, to stop the reaction.

Easy bruising. Certain arthritis medications can increase the risk of bruising either by thinning the skin or interfering with blood clotting. These include aspirin and corticosteroid medications such as prednisone.

Sun sensitivity. Some drugs can increase 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).

When taking medications that increase sun sensitivity, it's important to avoid direct sunlight, especially between the hours of 10 a.m. and 2 p.m., and tanning beds. When outdoors, wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, and use a sunscreen with an SPF of 30 or more that is protective against both UVA and UVB rays.

WebMD Medical Reference

Reviewed by David Zelman, MD on July 25, 2012
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