Rheumatoid arthritis is an autoimmune disease that affects joints, leading to pain, inflammation, swelling, and, ultimately, irreversible damage. However, it can also affect many other body parts and systems, including the lungs, nervous system, heart, and skin. Some people with rheumatoid arthritis develop rashes, which can put a significant damper on quality of life and body image.

In this article, we’ll look at 7 common signs of rheumatoid arthritis that manifest in the skin and discuss symptom management options. The skin-related symptoms of rheumatoid arthritis can be challenging, but there’s much you can do through personalized dietary and lifestyle modifications to ease symptoms.

How Does Rheumatoid Arthritis Affect the Skin?

Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis, affecting at least 1.3 million people in the United States. The disease primarily targets the joints, usually starting with the hands, wrists, and knees but then progressing to others. It inflames the lining of the joints, causing joint destruction and chronic pain. Left untreated, it can lead to significant and irreversible loss of cartilage and bone. (Source)

However, as our understanding of RA grows, it becomes clear that this condition can affect other body parts and systems beyond the joints. A subset of people with RA experience skin symptoms, namely rheumatoid nodules and rashes. (Source)

What Are Rheumatoid Arthritis Nodules?

Rheumatoid nodules are hard lumps that form under the skin in about 20%–30% of people with RA. These nodules commonly develop on tendons in parts of the body that experience recurrent pressure or movement, such as the hands, wrists, elbows, and backs of the heels. The nodules may be firm and stay in place, or may be soft and movable.

It is unclear why rheumatoid nodules form. However, inflammatory immune cells can be found in them, suggesting this skin condition is related to the overarching inflammatory process involved in RA. While rheumatoid nodules often produce no symptoms, in some cases, they can become infected, necessitating acute medical treatment. (Source, Source)

What Does a Rheumatoid Arthritis Rash Look Like?

Rheumatoid arthritis rashes can take on a variety of forms. The most common RA rashes are vasculitis, hives, livedo reticularis, and palmar erythema. Less common types of RA rashes include papules, which are small raised bumps on the skin, and plaques, which are patches of skin that are flat and often thickened.

Rheumatoid Vasculitis

Rheumatoid vasculitis is a skin condition that most often occurs in long-standing rheumatoid arthritis. It happens when the blood vessels that deliver blood to the body’s organs and tissues become inflamed. The rash that results on the skin from underlying blood vessel inflammation can be red, burgundy, or purple in color, depending on skin tone. It can appear as patches of discoloration or collections of pinpoint dots on the skin.

Sometimes, rheumatoid vasculitis can also manifest as sores around the fingernails. Bywaters lesions, a subtype of rheumatoid vasculitis that shows up as small purple dots on the fingers and around fingernail beds, may also occur.

Rheumatoid vasculitis can be quite painful. In severe cases of rheumatoid vasculitis, the affected tissues can begin to die due to a blockage of blood flow, causing painful ulcers that necessitate medical treatment. (Source)  

Hives

People with RA can also experience hives. Hives are red, raised, and itchy bumps on the skin. While hives have long been recognized as a symptom of allergic responses, they are increasingly becoming acknowledged as a skin reaction in people with RA and other autoimmune conditions. (Source)

In people with lighter skin, hives are typically pink or red. In people with darker skin, skin reddening associated with hives isn't always visible, though the skin may still appear inflamed and irritated.

Livedo Reticularis

While not unique to RA, livedo reticularis is a third type of rash that can occur in people with RA, as well as in people with other types of autoimmune conditions, such as lupus. This rash manifests as a distinctive blue or purple net-like pattern on the skin’s surface, caused by impaired blood flow in the blood vessels beneath the skin. The rash may appear brown or dark purple in people with darker skin tones.

Livedo reticularis can be short-lived or chronic in people with RA, and typically becomes more obvious in cold weather. This rash can also be a symptom of other significant health conditions besides autoimmunity, such as cardiovascular disease and cancer, so it is crucial to have your doctor check it out if you’re experiencing this type of rash. (Source, Source, Source)

Palmar Erythema

Palmar erythema, also called “liver palms,” is a red rash that can occur on the palms of the hands in people with RA. While it most commonly affects the palms, it occasionally can spread to the fingers. Palmar erythema is often asymptomatic in people with RA, though the palms may occasionally feel warmer than normal. (Source)

Skin Papules and Plaques

While rheumatoid vasculitis, hives, and livedo reticularis are the most common skin-oriented symptoms of RA, two rarer skin symptoms that can occur include papules and plaques. Papules are small, raised bumps on the skin, whereas plaques are flat patches of skin that may either be depressed or thickened.

Papules or plaques may occur in RA due to elevated levels of specific types of immune cells, called neutrophils, in the skin. These rashes often occur on the trunk of the body and in skinfolds, such as the skin around the armpits. (Source)

Rashes Caused by Rheumatoid Arthritis Treatment

Finally, in some cases, rashes can be caused by RA treatments. Rashes may develop as an allergic response to certain RA medications. Medications used for RA treatment that may trigger rashes include:

• celecoxib (Celebrex)
• sulfasalazine (Azulfidine)
• hydroxychloroquine (Plaquenil)
• naproxen (Aleve)
• Ibuprofen (Motrin)
• methotrexate
• diclofenac (Voltaren)

If you have RA and think you’ve developed a rash as a side effect of a medication, it is important that you speak with your health care provider. Your provider may recommend changing the dose or the type of medication you’re taking.

With any RA rash, the more severe and poorly managed the RA, the more severe the rash will tend to be. Untreated RA rashes can have significant health consequences, including the formation of ulcers or lesions on the skin. If you are experiencing skin-related symptoms of RA, it is crucial to address these symptoms with the help of your health care team as soon as possible.

In summary, 7 skin-related signs that you have RA include:

1. nodules, especially on your hands, wrists, elbows, knees, and the backs of your heels
2. red, burgundy, or purple rashes
3. sores on the skin around your fingernails
4. hives
5. livedo reticularis, a net-like blue and purple rash
6. papules
7. plaques

What Can You Do About a Rheumatoid Arthritis Rash?

In conventional medicine, the frontline treatments for RA rashes are medications that suppress underlying inflammatory processes, including disease-modifying antirheumatic drugs (DMARDs). In addition, painful RA rashes may warrant treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). Severe RA rashes may also be treated with topical antibiotics and ointments to prevent infection and reduce swelling.

There is little research on holistic strategies for managing rheumatoid arthritis rashes. However, nutrition and lifestyle strategies that reduce inflammation and balance the immune system may significantly reduce symptoms of RA rashes and support clear, healthy skin. For example, natural alternatives to NSAIDs may help manage pain and inflammation associated with RA rashes, while nutrition and lifestyle changes like adding omega-3 fatty acids and curcumin can reduce RA inflammation and balance the immune system.

The Bottom Line on Rheumatoid Arthritis Rashes

Rheumatoid arthritis rashes vary widely in appearance and severity, ranging from mildly irritating to severe. However, no matter the RA rash you're experiencing, it can significantly reduce your quality of life and self-confidence and may have significant health consequences if left untreated. The good news is that RA rashes are not a life sentence; with the proper care, you can manage your RA and even reduce symptoms such as rashes, allowing you to live a healthier life and enjoy clearer skin with RA.