Rheumatoid Arthritis and Neuropathy

Medically Reviewed by Sabrina Felson, MD on March 29, 2022
5 min read

Rheumatoid arthritis (RA) is an autoimmune disease where your immune system attacks the joints, places where two bones meet, across your body. This causes damage and inflammation in your joints that can be painful and affect your daily life. Sometimes symptoms will pop up elsewhere and change. One common complication of RA is peripheral neuropathy. That’s when the swelling and irritation that come with RA can lead to nerve damage. But how do you know if you have it? And does it matter if your RA is mild, moderate, or severe?

RA can hurt your peripheral nerves, which are part of the peripheral nervous system. That’s the communication system that helps your central nervous system (brain and spinal cord) send and receive information throughout your body. Most often this damage happens in your hands and feet. Usually this condition, called peripheral neuropathy, results from your nerves being compressed in RA. This can happen because of an inflamed joint (synovitis), an inflamed tendon (tenosynovitis ), or partial dislocation of a joint. Very rarely it’s caused by rheumatoid nodules, which are lumps or masses under the skin.

Not everyone who has peripheral neuropathy has RA, though. There are other much more common causes. More than half the people who have diabetes get it. Other causes include injuries, infections, and exposure to toxins.

Neuropathy can feel like burning or tingling, and sometimes also feel like stabbing pain. Sometimes it can also cause weakness and numbness. It can start gradually, moving up from your feet or hands toward your legs or arms. Some people describe it as feeling like you’re wearing gloves or socks even when you aren’t. Symptoms can get better with treatment. The specific symptoms depend on which nerves are affected, such as:

  • Sensory nerves in the skin that make you feel temperature, pain, or touch
  • Motor nerves that control your muscles
  • Autonomic nerves that control your body’s basic functions, such as blood pressure, heart rate, and digestion

Overall, 4-5 in 10 people with RA will develop some type of peripheral neuropathy. The most common type is compressive neuropathy, in particular carpal tunnel syndrome. This condition, where nerves in the wrist are squeezed too tightly, affects around 10% of people with RA. Tarsal tunnel syndrome, seen in the toes and feet, probably affects a similar proportion, though symptoms can be mild and overlooked. Less common types of compressive neuropathy affect a nerve at the elbow or another nerve at the elbow or wrist.

The chance of having peripheral neuropathy is higher as you grow older and have RA for a longer time. It also depends on how bad your disease is. If you have mild RA, your likelihood of having neuropathy is lower, for example, than it would be for someone with more serious disease. Apart from RA itself, other factors that raise the risk include diabetes, drinking too much alcohol, vitamin deficiencies, activities that require repeatedly doing the same body motions, and family history of neuropathy.

Depending on how bad your RA is, your neuropathy symptoms may be overlooked at first. Check with your primary care doctor and rheumatologist if you believe you have the condition. It can sometimes be hard to tell whether what you feel is coming from your arthritis itself or from nerve damage.

Your doctor will ask you about your disease history and symptoms. They’ll also do a physical exam. To test your nerve function, your doctor starts by checking your reflexes, coordination, balance, strength, and ability to feel things like touch or temperature. You may have blood tests to see if there are issues beyond your RA causing your tingling nerves, such as not enough of certain vitamins, diabetes, or problems with electrolytes. Also, MRI can help see what’s going on inside your body, whether nerves are pinched, for example. Ultrasound imaging is another option that may be cheaper than an MRI.

If RA is suspected, your health care provider may refer you to a nerve specialist, who can pinpoint where and how badly your nerves are damaged. In this visit, tests include a nerve conduction study (NCS) and electromyography (EMG). Both test how well electrical signals travel in your nerves. Keep in mind that it’s possible for these tests to miss a diagnosis. Trust yourself and clearly communicate with your doctor about your symptoms. This is especially true for tarsal tunnel syndrome.

Less common tests include a tissue biopsy to confirm your diagnosis as well as a quantitative sudomotor axon reflex test (QSART), which checks your body’s ability to sweat.

Many treatments are available to relieve your symptoms and prevent further nerve damage. They include:

  • Medications that adjust the way your nerves send signals, which can ease your pain. Among them are antidepressants, antiseizure drugs, and topical patches and creams
  • Physical therapy to improve your strength, balance, and movement
  • Occupational therapy that gives you skills to deal with day-to-day demands
  • Surgery to relieve pinched nerves
  • Transcutaneous electrical nerve stimulation (TENS) to disrupt pain signals
  • Therapies aimed at your autoimmune disease itself
  • Complementary treatments like acupuncture, massage, and supplements (such as fish oil to reduce inflammation)

For carpal tunnel syndrome, try to treat your symptoms when they first appear. To help yourself, you can take breaks to rest your hands and use cold packs to reduce swelling. If your symptoms are mild to moderate and have lasted less than 10 months, wrist splinting and self-care may be enough to make them go away. You can use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce your pain, but there’s no evidence they actually treat your carpal tunnel syndrome. For very bad symptoms, your doctor can inject your nerve with a corticosteroid. That will lessen both inflammation and swelling. Similarly, treating the RA itself could potentially offer relief. And finally, if symptoms are especially bad, surgery can be done to release your pinched nerve.

Your symptoms may be just a mild tingle as peripheral neuropathy starts. But if you don’t get treated, your symptoms will likely get worse, with pain and weakness. The earlier you know your diagnosis, the earlier you can get treatment that may slow down or repair your nerve damage. It can take months or even years to heal. Whether or not you’ll fully recover depends on the type of neuropathy you have and what’s causing it. If your RA is more serious, it’s possible that your nerves may have some sort of permanent damage. If that’s the case, your best options are to find ways to control your symptoms and improve your quality of life. Yet there is some hope even in these cases: studies are exploring treatments that might one day be able to restore your nerves to health.