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Can Rheumatoid Arthritis Cause a Rash?

Rheumatoid arthritis (RA) can cause a rash when it affects the blood vessels. This condition is called rheumatoid vasculitis (RV), a rare and serious complication caused by RA. The main symptoms of rheumatoid vasculitis include skin rash, small pits on the fingertips, sores and redness around the nail, and numbness, tingling, and pain of the hands and feet.
Rheumatoid arthritis (RA) can cause a rash when it affects the blood vessels. This condition is called rheumatoid vasculitis (RV), a rare and serious complication caused by RA. The main symptoms of rheumatoid vasculitis include skin rash, small pits on the fingertips, sores and redness around the nail, and numbness, tingling, and pain of the hands and feet.

Rheumatoid arthritis (RA) is an autoimmune disease, in which the body’s immune system mistakenly attacks its own tissues. In rheumatoid arthritis, the joints are primarily affected though it can affect other parts of the body. 

When rheumatoid arthritis affects the blood vessels, it is called rheumatoid vasculitis (RV), which is a rare and serious complication that occurs in less than 1% of patients with RA. Rheumatoid vasculitis affects the whole body (it is systemic), and it can also impact the heart, kidneys, gastrointestinal tract, brain, or lungs.

The main symptoms of rheumatoid vasculitis include:

  • Skin rash
  • Small pits on the fingertips 
  • Sores and redness around the nail
  • Numbness, tingling, and pain of the hands and feet

The first signs and symptoms of rheumatoid arthritis tend to come on gradually, often before joint pain or stiffness is noticeable, and may include:

Joint pain and stiffness usually starts in the small joints, such as the joints at the base of the fingers, the middle of the fingers, and the base of the toes, or it may occur in a single, large joint, such as the knee or shoulder, or it may shift from one joint to another

Rheumatoid arthritis usually affects the same joints on both sides of the body (symmetrical). As the condition progresses, joint pain and inflammation become more noticeable and symptoms include: 

  • Joint pain and stiffness that may affect the:
    • Hands
      • Finger deformities/bent fingers 
      • May result in carpal tunnel syndrome, which causes weakness, tingling, and numbness in the hand and fingers
    • Wrist: difficulty bending the wrist backward
    • Elbow: swelling may result in numbness or tingling in the fingers
    • Shoulder: pain and limited motion
    • Knee: difficulty bending the knee and development of a “Baker's cyst,” which is a fluid-filled cyst in the space at the back of the knee
    • Ankle: nerve damage may occur, leading to numbness and tingling in the foot
    • Foot: tenderness at the joints at the base of the toes may cause someone to stand and walk with weight on the heels. The top of the foot may be swollen and red, and the heel may be painful.
    • Hips: difficulty walking
    • Neck: painful and stiff, difficulty bending the neck and turning the head
    • Cricoarytenoid joint: inflammation of a joint near the windpipe that can cause hoarseness and difficulty breathing
  • Other symptoms of rheumatoid arthritis may include:

What Causes Rheumatoid Arthritis?

It is unknown what causes rheumatoid arthritis but it is thought that susceptibility factors and initiating factors may affect a person's risk of developing the condition: 

Susceptibility factors increase a person’s susceptibility to developing rheumatoid arthritis when exposed to risk factors that initiate the inflammatory process. Susceptibility factors include:

  • Age: middle-aged or older
  • Female sex: twice as likely as men to develop RA
  • Genetics: people with a relative who has RA have an increased risk of developing the condition

Initiating factors (triggers) increase the chances a susceptible person will develop the disease, such as:

It is unknown what causes some rheumatoid arthritis patients to develop rheumatoid vasculitis. Risk factors that may increase the chances a person with RA will develop RV include:

  • Chronic, severe RA, for 10 years or more
  • Smoking 
  • High concentrations of “rheumatoid factor” antibodies and certain other proteins in the blood
  • Felty’s syndrome, a complication of RA 
  • The presence of rheumatoid nodules

How Is Rheumatoid Arthritis Diagnosed?

Rheumatoid arthritis is diagnosed with a combination of clinical, laboratory, and imaging information. 

Laboratory studies used to diagnose rheumatoid arthritis include:

Imaging studies used to diagnose rheumatoid arthritis include:

  • X-rays (first choice): Hands, wrists, knees, feet, elbows, shoulders, hips, cervical spine, and other joints as indicated 
  • Magnetic resonance imaging (MRI): Primarily cervical spine
  • Ultrasound of joints: Joints, as well as tendon sheaths, changes and degree of vascularization of the synovial membrane, and even erosions

Joint aspiration and analysis of synovial fluid may be indicated, including:

  • Gram stain 
  • Cell count 
  • Culture 
  • Assessment of overall appearance 

Rheumatoid vasculitis may be suspected based on a patient’s symptoms, including rash. Other diseases that cause similar symptoms and can also cause narrowing of blood vessels, including other forms of vasculitis, diabetes, and atherosclerosis, must be ruled out. 

Tests used to diagnose RV or to rule out other possible causes of symptoms may include of the tests listed above that are used to diagnose RA, as well as: 

  • Computed tomography (CT) 
  • Angiogram (X-ray of blood vessel after injection of contrast dye)
  • Electrocardiogram (ECG) to check heart rhythm
  • Endoscopy
  • Nerve conduction (EMG) to test nerve function
  • Tissue biopsy (usually required to confirm the diagnosis)

What Is the Treatment for Rheumatoid Arthritis?

Medications used to treat rheumatoid arthritis include:

Other medicines used to treat rheumatoid arthritis include:

Surgical treatments for rheumatoid arthritis include:

  • Synovectomy 
  • Tenosynovectomy 
  • Tendon realignment 
  • Reconstructive surgery or arthroplasty 
  • Arthrodesis 

Other therapies for rheumatoid arthritis include:

  • Physical therapy and exercise 
  • Occupational therapy 
  • Heat and cold therapies 
  • Joint-protection education 
  • Orthotics and splints 
  • Adaptive equipment 
  • Energy-conservation education 

Treatment for rheumatoid vasculitis involves managing the underlying rheumatoid arthritis. Drugs used to treat RA may also improve symptoms of RV. Other treatment for RV may include: 

  • For mild disease:
    • Protecting areas with sores to prevent infection
    • Use of topical corticosteroids, such as prednisone
  • For more widespread disease
    • Corticosteroids in combination with immunosuppressants, such as methotrexate or azathioprine
  • For more serious organ involvement 
  • Don’t smoke, since RV is associated with smoking

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References
https://emedicine.medscape.com/article/331715-overview

https://www.uptodate.com/contents/rheumatoid-arthritis-symptoms-and-diagnosis-beyond-the-basics?search=rheumatoid%20arthritis&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5

https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics?search=rheumatoid%20arthritis&topicRef=512&source=see_link

https://www.vasculitisfoundation.org/education/forms/rheumatoid-vasculitis/