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Could that itch be related to RA?

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 RA symptoms 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 study

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 over exposed 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 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 conditions associated with RA

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, 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. http://www.nras.org.uk/about_rheumatoid_arthritis/established_disease/possible_complications/rheumatoid_nodules.aspx
  2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754657/
  3. http://www.dermnetnz.org/immune/rheumatoid.html
  4. http://www.reumatologiaclinica.org/en/pulmonary-rheumatoid-nodules-presentation-methods-/articulo/90149847/
  5. http://onlinelibrary.wiley.com/doi/10.1002/art.33358/full
  6. http://www.hss.edu/professional-conditions_which-treatments-worsen-resolve-rheumatoid-nodules.asp
  7. http://www.japi.org/february_2013/08_pc_subcutaneous_modules_in_rheumatoid.html
  8. http://ard.bmj.com/content/71/8/1429.short
  9. http://rheumatology.oxfordjournals.org/content/early/2013/01/16/rheumatology.kes406.short
  10. http://www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/urticaria
  11. http://www.tsim.org.tw/journal/jour21-4/08.PDF
  12. http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-rheumatoid-vasculitis.aspx
  13. http://dermnetnz.org/vascular/livedo-reticularis.html
  14. http://www.medscape.com/viewarticle/712251_2
  15. http://umm.edu/health/medical/reports/articles/rheumatoid-arthritis

Comments

  • jan curtice
    3 years ago

    HIVES! Thank you for writing about these vicious assaults on our skin. I am so sorry to learn you are suffering from them. For me, they strike without warning and within a matter of minutes I can be covered with them (either or both bumps and whelps) The worst ones are on my scalp, so I am now rocking a short hairstyle. The dermatologist sent me back to my rheumatologist because of the RA connection. I have found that following the medication warning to stay out of the sun, vistaril, keeping my house cool, unscented products, and Solarcaine help. I also have a cortisone shampoo and ointment. Still it is probably one of the nastier aspects of RA I have to deal with and for some reason, it often comes with a migraine and nausea. My heart goes out to those of you who also struggle with this. =^^=

  • Andrew Lumpe, PhD moderator author
    3 years ago

    Sorry for your skin issues Jan. 🙁 Can you tolerate the vistaril w/o it knocking your brain out?

  • Carolyn Haney
    3 years ago

    Thank you for this information. I was diagnosed with RA about 5 years ago but about 6 months ago I had a rash that was very uncomfortable. I was told to stop my Sulfasalazine and took steroids by mouth but nothing worked, I finally went to a dermatologist and was diagnosed with Lichen Planus. I tried the meds he gave me but they didn’t work. I went back a third time and was told I needed to try Methotrexate because the rash was an inflammatory skin condition but I’m afraid to take it. My Sulfasalazine is keeping my RA inflammation low so why add that med to my long list of medications? Has anyone else ever heard of this condition? Thanks!

  • Andrew Lumpe, PhD moderator author
    3 years ago

    Hi Carolyn,
    Glad you liked the article. I’ve never heard of lichen planus but it appears to an autoimmune caused skin disease. You should really try the methotrexate if your doctor is prescribing it. Millions of people take it for RA.
    Andrew

  • Christy
    5 years ago

    Thanks for writing about this. I’ve had a couple issues with severe hives and rashes, and have had Raynaud’s since age 14, but my rheumatologist has written all these off as “totally separate issues from RA.” I’ve always suspected them to be more interrelated than he cares to admit.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Christy, glad you like the article. Raynaud’s is widely accepted as being a secondary condition of RA.

  • Kat
    5 years ago

    Besides myself, my mother has RA and she has terrible issues with hives. She has been going crazy convinced it’s ingredients of her meds or food additives. She did discover a few new allergies since the RA (annatto (http://en.wikipedia.org/wiki/Annatto), and yellow food coloring). She also became allergic to latex (band-aid adhesive, etc.) shortly before her diagnosis. She has to carry an epi-pen now because we never know what’s going to set her off. She never used to have many/severe allergies until around the time of the RA Dx, now it seems there are new ones all the time.

  • Leslie Rott moderator
    5 years ago

    Andrew, thanks for this post. I have recently developed nodules in my foot, which I am planning to write a post about for my blog. I have also had issues with widespread itching. It has always been attributed to my lupus and not my RA, and I have yet to find any comprehensive way of dealing with these attacks that come on at random.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    You’re welcome Leslie. Yes, patients with lupus probably have more skin issues but as you know, autoimmune diseases are complex and not always easy to put into predefined boxes.

  • Carla Kienast
    5 years ago

    Hi, Andrew. Thanks for the post. It was very timely for me. I’ve just had some red, itchy patches show up (along with increased RA symptoms). They look suspiciously like psoriasis which, as you know, is also an inflammatory condition. I’ve got my regular rheumy appointment coming up, but if the areas don’t clear up before then, I’m going to my dermatologist first to rule out other possibilities.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Carla, hope it’s no big deal and clears up soon.

  • Kathy P.
    5 years ago

    Thanks for your column, Andrew. I didn’t know that and it explains a lot!

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Glad you liked the article Kathy.

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