Skin Issues Associated with RA
About the time I first ventured into a rheumatology clinic after being referred by my general practitioner, I had been battling a nasty case of hives for the previous year or so. The itching drove me crazy at times and I took an over-the-counter antihistamine to control it. My medical record still lists urticaria, the medical term for hives, as one of my “conditions”. The referral was based on traditional RAsymptoms but when my rheumatologist learned about the hives, he mentioned that it was probably related to RA since it all involved the immune system. In a previous post, I outlined how RA can impact parts of the body other than joints and there are several skin issues that are related to rheumatoid arthritis.
Nodules are the most common skin condition from RA
Nodules are among the most common skin condition from RA. According to the National Rheumatoid Arthritis Society (NRAS) in the United Kingdom,
“Rheumatoid nodules are firm lumps that appear subcutaneously (i.e., under the skin) in about 20% of patients with rheumatoid arthritis. These nodules usually occur overexposed joints that are subject to trauma, such as the fingers joints and elbows, though occasionally they can occur elsewhere such as the back of the heel.”1 In one study of RA patients, the most prevalent extra-articular (outside the joint) presentation was nodules appearing in 24.5% of the sample.2
What are nodules?
According to a dermatological overview on the topic, the nodules consist of inflammatory tissue that contains cells such as lymphocytes and other white blood cells.3 The lumps are usually hard and painless and do not typically require any treatment although they may be removed surgically if needed. Nodules are usually benign but sometimes get infected. Nodules tend to be more common with patients with severe and aggressive RA disease symptoms, who are rheumatoid factor (RF) positive, and who display additional extra-articular symptoms including vasculitis (inflammation of blood vessels) and lung disease. Nodules can even develop in the lungs.4
Where do nodules come from?
The exact source of nodules is unknown but some researchers are beginning to argue that rheumatoid nodules may be related to genetic material that originated from the mother during pregnancy – called microchimerism.5 According to Dr. Paget at the Hospital for Special Surgery in New York, patients who use high doses of methotrexate are more prone to develop nodules and the reasons for this are unclear.6,7
But there has been a decline in the presentation of nodules over the past few years probably attributed to the use of biological treatments. One group of researchers demonstrated cases where increases of lung nodules were seen in patients using TNF blockers that then decreased after stopping the TNF blocker and switching to Rituxan.8 Supporting this study, other researchers documented that the use of Rituxan effectively treated subcutaneous nodules.9
Other skin problems associated with RA
Chronic hives (urticaria)
In addition to nodules, several other less common skin conditions can be associated with RA. As mentioned earlier, chronic hives or urticaria can occur with RA. Allergists recognize that chronic hives can be a symptom of RA.10 In one study, 24% of patients with chronic hives also displayed an autoimmune condition.11
Skin vasculitis & livedo reticularis
Skin vasculitis, inflammation of the blood vessels in the skin, can be a complication of RA and may be a sign of more serious vasculitis involving vessels and arteries throughout the body.12 Livedo reticularis is a secondary condition of RA that involves dilation of blood vessels in the skin and causes a mottled, purple discoloration.13 Deformities including ridges in the fingernails can also be seen in RA patients.14 At one time I had such symptoms and my rheumatologist said that nail changes could be symptomatic of chronic diseases.
Skin problems are considered to be indicative of more serious cases of RA.15 If you have skin conditions and believe that they may be related to RA, please speak to your doctor.
When was your last flare?