Rashes Associated with Rheumatoid Arthritis

Many people equate rheumatoid arthritis (RA) with joint pain, which makes sense. This inflammatory disease attacks healthy tissue in the joints, leading to swelling and reduced mobility, according to the Centers for Disease Control and Prevention (CDC). But the systemic effects of RA aren't limited to the joints. Your skin may be susceptible too.

Skin rashes are more often associated with psoriatic arthritis—a disease that causes joint swelling and rashes. Still, people with RA can develop rashes as well.

One type of rash, in particular, rheumatoid vasculitis, acts as a warning sign about the overall status of your RA. 

"It's not common, but we do see rheumatoid vasculitis in patients with uncontrolled RA," said Juan J. Maya, MD, a rheumatologist at the Rheumatology Center of Palm Beach in Florida. "Luckily, by treating RA, you can control rheumatoid vasculitis."

How do you know if you have rheumatoid vasculitis? And what can you do about it? Here's everything you need to know about this RA-related rash (as well as a few others you might experience).

What Is Rheumatoid Vasculitis?

Rheumatoid vasculitis is a rare but serious symptom of uncontrolled or poorly managed RA, said Robert Koval, MD, a rheumatologist at Texas Orthopedics.

It occurs when the blood vessels are inflamed, which can affect the skin, nerves, fingers, and toes, according to the Vasculitis Foundation. Rheumatoid vasculitis causes numbness, tingling, joint pain and swelling, and blotchy red lesions on the extremities.

It can sometimes affect your internal organs as well. So while it's unlikely, you'll experience rheumatoid vasculitis if you have RA, if you do, you need to see your healthcare provider right away. Per the Foundation, rare cases can cause heart attack, stroke, or kidney failure.

What Does Rheumatoid Vasculitis Look Like?

Rheumatoid vasculitis is hard to miss. 

"Visually, I can recognize it right away," said Dr. Koval. "It's an impressive rash with a sudden onset and can be scary looking." 

According to the Vasculitis Foundation, rheumatoid vasculitis can appear as any of the following:

• Small pits on the fingertips
• Painful, red rash (usually on the legs)
• Purple bruises
• Redness or sores around the nails

What Are Other Symptoms of Rheumatoid Vasculitis?

According to the Foundation, in addition to a telltale rash, people with rheumatoid vasculitis can also have other symptoms including:

• Fever
• Fatigue
• Loss of appetite
• Weight loss
• Tissue death (necrosis) of the fingers or toes
• Numbness
• Tingling
• Muscle weakness
• Chest pain
• Abdominal pain

What Causes Rheumatoid Vasculitis?

According to Dr. Maya, rheumatoid vasculitis is an immune reaction that has to do with the heightened autoimmune state related to RA. 

However, beyond that, experts still don't exactly know what causes it. It's most likely a combination of uncontrolled RA, genetic predisposition, drug reactions, and infection or virus. It's also thought that higher levels of certain antibodies and proteins often found in the blood of people with RA may contribute to the risk.

How Is Rheumatoid Vasculitis Treated?

If a diagnosis of rheumatoid vasculitis is confirmed, your healthcare provider will start by treating the rash with corticosteroids (such as prednisone) to prevent infection. If the disease is more widespread, you may also be treated with immunosuppressants, according to the Vasculitis Foundation.

Next, you and your healthcare provider will have to discuss how to better manage your RA since these rashes are most common in advanced cases. 

"If your disease is flaring up, we would talk about adding a short course of a steroid or advancing [your RA] therapy to an immunosuppressant," Dr. Koval explained.

Other Rheumatoid Arthritis Rashes

Besides rheumatoid vasculitis, RA can also cause other rashes.

Livedo Reticularis

Livedo reticularis is a skin condition that involves swollen blood vessels. It may look reddish-blue, is commonly seen on the legs, and may be brought on by colder temperatures, according to the National Library of Medicine. This benign rash develops in a lacy pattern, said Dr. Koval.

Medication Rashes

People with RA are often on several different medications. Dr. Maya explained that any of them may cause a rash depending on a person's allergic response. Additionally, the medication d-Penicillamine is used to treat RA and can cause a side effect of a severe rash, according to the Johns Hopkins Medicine Health Library.

Eczema

Eczema and rheumatoid arthritis often go hand in hand. A 2021 review and meta-analysis in Allergy, Asthma & Clinical Immunology found that people with eczema (also known as atopic dermatitis) are at higher risk of autoimmune disease, including rheumatoid arthritis.

Rheumatoid Neutrophilic Dermatitis

This rare skin manifestation of RA can produce red bumps, nodules, plaques, or itchy skin patches, according to a 2019 report in the journal Reumatologia. It occurs more commonly in people with severe arthritis and can be treated with topical corticosteroids.

A Quick Review

Although uncommon, rheumatoid arthritis can cause different rashes, including rheumatoid vasculitis. Rheumatoid vasculitis usually presents in people with uncontrolled RA and can be managed with treatment.

If you have rheumatoid arthritis and notice a rash on your body, you should seek care from your healthcare provider. 

Regardless of what your symptoms are or what kind of rash you think you have, you shouldn't ignore it, said Dr. Koval: "Any rash in RA should prompt a patient to seek medical attention."