When Rheumatoid Arthritis Causes Skin Problems

Medically Reviewed by Shruthi N, MD on August 19, 2024
11 min read

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that mainly affects your joints. But RA and many of the medications that treat this bodywide inflammatory condition can also affect the skin.

Around 1 in 3 people with rheumatoid arthritis may get RA-related skin issues. This includes nodules, rashes, sores, nerve problems, and other symptoms.

Here’s more about what you need to know when it comes to rheumatoid arthritis skin problems.

Rheumatoid vasculitis (RV) is inflammation of the small and medium-sized blood vessels. Only about 1 in 100 people with rheumatoid arthritis get vasculitis. The most commonly affected blood vessels are arteries that carry blood to the skin, nerves, and internal organs.

Untreated vasculitis can damage and weaken your blood vessels. Your skin and other organs may not get enough blood and oxygen when this happens.

Symptoms of rheumatoid vasculitis include:

  • Sores or discoloration on or near your fingertips and nails
  • Deep leg sores (ulcers)
  • Skin rashes or bumps
  • Pain in your hands, fingers, feet, or toes
  • Bruising
  • Pins and needles or numbness in places such as your hands and feet
  • Weak muscles
  • Inflammation in the white part of your eye (scleritis)

Rheumatoid vasculitis can affect your whole body, causing general symptoms such as:

  • Belly pain
  • Not feeling hungry
  • Weight loss
  • Fever 
  • Cough
  • Chest pain
  • Tiredness that doesn’t go away

Tell your doctor right away if you have any of the above symptoms. Vasculitis can be serious and needs fast treatment. 

Who gets rheumatoid vasculitis?

You’re more likely to get rheumatoid vasculitis if you’ve had RA for a long time (more than 10 years). By the time you get RV, your joints are usually severely damaged and misshapen due to long-term arthritis.

Things such as your age, gender, race, or ethnicity usually don’t raise your chances of getting RV, but you’re more likely to get it if you:

  • Have an enlarged spleen and low white blood cell count (Felty syndrome)
  • Have rheumatoid nodules
  • Smoke cigarettes or use tobacco products (smoking can damage your blood vessels)

Skin rashes aren’t a common symptom of rheumatoid arthritis, but you may get them from:

Vasculitis. Inflammation that damages your blood vessels can limit blood flow to your skin. Symptoms depend on which blood vessels are involved and how serious the damage is.

If you have vasculitis, you may get:

  • A rash of small red dots that don’t itch (petechiae)
  • Red or purplish raised spots or patches (purpura)
  • A painful or tender rash or open sores, often on your legs or lower body

Palindromic rheumatism. This is a type of arthritis that can cause fast swelling of your joints, along with a red or purple rash around the area that’s swollen. These episodes can last for several hours or days. Around half of people who get palindromic rheumatism get RA later on.

Medication. Skin rashes can be a side effect of RA treatment. Tell your doctor if you think this is happening to you. They might want to change your dose or switch you to something else to manage your inflammation.

Juvenile rheumatoid arthritis rash

About 1 in 1,000 children with rheumatoid arthritis get a kind of RA that affects their whole body. You may hear this called systemic juvenile idiopathic arthritis (JIA). Kids with systemic JIA can get a high fever and skin rash.

Rashes may look different or be harder to see on kids with darker skin. This can make diagnosing arthritis-related rashes more difficult in children of color. But rashes that come and go without a fever usually aren’t related to RA or other rheumatoid conditions.

Children who have juvenile psoriatic arthritis may also have skin problems. PSA can cause a kind of rash with red or purplish scales (an outer layer of skin that flakes or peels off).

Psoriasis rashes may look different depending on your child’s skin tone:

  • On lighter skin, psoriasis may be red and covered with silvery scales.
  • On black or darker skin, the rash may look more purple or brown with thick gray scales.
  • On brown or medium-toned skin, the rash may be pinkish with silvery scales.

Rheumatoid skin ulcers are open sores or wounds. They may be red, swollen, or yellow (from pus). You may get them for the following reasons:

  • Vasculitis stops blood flow to your skin.
  • Inflammation slows wound healing.
  • You put a lot of pressure on certain parts of your skin.
  • You have Felty syndrome (a condition that makes it hard to fight infections).

Rarely, you may get a condition called pyoderma gangrenosum. You may get large, painful ulcers, usually on your legs, that grow quickly. You’ll need treatment right away.

Rheumatoid skin ulcers often show up on your legs. Your odds of getting these kinds of sores go up the longer you have RA. One study found that around 1 in 4 people developed a leg ulcer 25 years after their diagnosis.

At some point in the disease course, around 1 in every 4 or 5 people with rheumatoid arthritis gets rheumatoid nodules. These are hard lumps of tissue that you can feel under your skin. They’re usually round and can be as small as a pea or as large as a lemon.

Rheumatoid nodules are the most common skin problem associated with RA. They typically form on bony areas of your body that you bend a lot.

Nodules often show up on joints like your:

  • Elbow
  • Ankle
  • Heels
  • Finger
  • Forearms

Rheumatoid nodules may be:

  • The same color as your skin
  • Moveable or attached to tissue
  • Doughy or firm
  • Painless (unless nerves are involved)

Less commonly, they may form around your eyes or on your vocal cords.

Rarely, you might get these nodules on organs such as your lungs. This typically happens in people who have seropositive RA and have been on treatment for a while. These nodules may form as a side effect of treatment used to manage RA.

This is a rare skin condition. You can only get it if you have RA, but it’s not caused by vasculitis. Instead, the lesions are made mostly of neutrophils (a type of white blood cell). You may get them on your arms, legs, chest, or belly area. Some people get them on their neck and scalp.

Symptoms of rheumatoid neutrophilic dermatitis (RND) may look different depending on the shade of your skin but typically include the following:

  • Red or bluish-purple bumps or nodules
  • Raised patches of flaky skin (plaques)
  • Swollen or hive-like spots
  • Lesions that don't hurt but might itch or feel tender

You might get RND even with good control of your joint inflammation. Though, the main risk factors for rheumatoid neutrophilic dermatitis include:

  • You’ve had severe rheumatoid arthritis for a long time.
  • Your disease is active.
  • You’re a woman or assigned female at birth.
  • You’re seropositive.

Lesions may go away on their own or get better with treatment without leaving a scar. You might have long-lasting changes in your skin color.

Rheumatoid neutrophilic dermatitis can seem like other skin conditions associated with RA, including Sweet syndrome. That’s a condition that affects your skin but makes you feel generally unwell. You may also get a fever or body aches, which doesn’t usually happen with RND.

Palmar erythema (PE) is a condition where the inside of your hands turn red. This usually affects the lower part of your palms, but your fingertips may also redden. Inflammation of the small blood vessels in your hands likely plays a role, but the exact cause of PE is unknown.

Around 1 in 3 people who are pregnant get palmar erythema due to skin, hormone, and blood vessel changes. Researchers have also found that more than 6 out of 10 people with RA may get PE at some point, but it usually gets better on its own. And it usually doesn’t itch or hurt.

Your symptoms may resolve when you get your inflammation under control. However, medication can sometimes cause palmar erythema. If this happens to you, your doctor might switch you to a different drug to treat your RA.

Inflammation is a natural part of healing. The body depends on this process to repair injuries and grow new tissue. But if you have an autoimmune condition such as rheumatoid arthritis, your immune system causes too much inflammation. Your body may get stuck in the wound-healing phase when this happens.

Just having an autoimmune disease seems to slow wound healing. Other things that might play a role include:

  • Your tissue can’t heal around a damaged or misshapen joint.
  • You have nerve damage. 
  • You have poor blood flow all over your body. 
  • Inflammation affects certain blood vessels around your wound.
  • You have another health condition such as diabetes or obesity.

Most wounds heal in 3 months or less, even really bad ones. If they don’t, you’re more likely to get an infection or more serious problems. Rarely, wounds that don’t heal need to be cut out or amputated.

Some studies show that certain biologics and disease-modifying antirheumatic drugs (DMARDs) may lower inflammation in a way that helps your RA symptoms but slows wound healing. Though, other researchers haven’t found these drugs to negatively affect how you heal.

Go over the pros and cons of all your RA treatment choices with your doctor. They’ll help you figure out which one is best to treat all your symptoms.

RA skin problems can sometimes be caused by the drugs you take to ease your symptoms. Drug-related skin problems include:

Skin rashes. A skin rash can be a sign of an allergic reaction to a drug. So, you should let your doctor know if your skin breaks out or starts itching.

Depending on the type of rash you have and how severe it is, your doctor may lower the dose or stop your medication altogether. In some cases, you may need another drug, such as a corticosteroid or antihistamine, to stop the reaction.

Easy bruising. Certain arthritis medications make you more likely to bruise because they thin the skin or interfere with blood clotting. These include aspirin and steroids such as prednisone.

Sun sensitivity. Some medicines can make your skin more sensitive to the sun. If you take medicines that do this, avoid direct sunlight, especially between the hours of 10 a.m. and 2 p.m. Don’t use tanning beds. When outdoors, wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat. Use a sunscreen with an SPF of 30 or more that protects against UVA and UVB rays.

Treatment for rheumatoid arthritis skin problems depends on your symptoms and what’s causing them. Depending on your situation, your doctor may suggest the following:

Rheumatoid arthritis rashes. Your doctor may give you corticosteroids, DMARDs, or other immunosuppressive treatments. If your rash is due to your medication, your doctor may change the dose or switch you to a different type of drug to see if your symptoms clear up.

Rheumatoid arthritis nodules. Your nodules may get better when you control your underlying inflammation, which means you may not need a specific treatment to get rid of them other than what you take to manage your RA.

If your nodules get infected, cause a lot of pain, or prevent you from moving parts of your body, your doctor might try to shrink or remove them with:

  • Steroid shots straight into the nodule
  • DMARDs
  • Surgery

Some DMARDs may trigger the growth of rheumatoid nodules. If that happens with the drug you’re taking, your doctor might switch you to a different one.

Rheumatoid vasculitis. Inflammation of your blood vessels can cause serious skin damage or other health problems. You’ll need strong and fast treatment, likely with strong steroids and other drugs to suppress your immune system. This may include targeted biologic drugs. 

Rheumatoid neutrophilic dermatitis. Your lesions may go away on their own. If they don’t, treatment for rheumatoid neutrophilic dermatitis may include:

  • Biologics or other immunosuppressants to treat your RA
  • Topical or systemic corticosteroids
  • Antimalarial drugs such as hydroxychloroquine
  • Cyclophosphamide

Ulcers or slow wound healing. Your doctor can let you know the best way to manage ulcers or other wounds that take a long time to heal. Treatment usually depends on the size, location, and severity of your wound.

For a small leg wound or sore, use these at-home tips:

  • Keep the area clean.
  • Cover the wound with a sterile bandage or gauze.
  • Change the bandage once a day or every other day.
  • If your dressing isn’t waterproof, keep it covered when you bathe or shower.
  • Get good nutrition.
  • Take anti-inflammatory drugs (if your doctor tells you to).

Medications used to treat moderate-to-serious ulcers or wounds that take a long time to heal may include:

  • Anti-inflammatory drugs
  • Immunosuppressive drugs
  • Steroids you rub on your skin or take by mouth
  • Biologics
  • Medications you get through a vein in your arm, such as intravenous immunoglobulin (IVIG)

Call your doctor right away if you have any signs of infection, including: 

  • Pain that doesn’t go away or gets worse
  • Dark or bluish coloring around the edges of the wound
  • Pus or other fluid that seeps out of the wound
  • Redness or swelling that spreads from the wound
  • A bad smell coming from your sore

Your doctor may send you to a wound clinic or other specialty care center if your ulcer or sore is really serious. Rarely, you may need surgery to remove the affected limb (amputation) if your wound won’t heal.

Rheumatoid arthritis (RA) is an autoimmune condition that mainly affects your joints. However, RA and some of the medications used to treat it may cause rashes or other skin problems. Your symptoms may get better when you get your inflammation under control. 

Tell your doctor if you think your skin problems are a side effect of your medication. Treatment for RA is the best way to ease symptoms such as rashes, nodules, or ulcers. But your doctor can adjust your dose or switch you to something else to see if your skin problems clear up.