What is a rheumatoid arthritis (RA) rash?

Rheumatoid arthritis (RA) is a chronic autoimmune condition.

RA primarily affects your joints, though lesser-known symptoms include an RA rash and other skin conditions. 

What is an RA rash? 

Individuals with RA may develop skin conditions, including an RA rash. RA rashes can vary significantly in appearance and severity. 

According to a 2017 clinical review, here are some of the ways RA can affect your skin:

• Rheumatoid vasculitis (RV): A condition where your blood vessels become inflamed. It can cause a painful red rash, often on the legs. It can also lead to ulcers, numbness, tingling, and nail issues.
• Livedo racemosa: A skin condition characterized by a lace-like, mottled pattern on the skin related to impaired blood flow.
• Raynaud’s phenomenon: A condition where your fingers and toes turn white, blue, or purple in response to cold or stress.
• Pyoderma gangrenosum (PG): A rare skin condition characterized by painful, rapidly progressing ulcers that can be swollen, tender, and itchy. It’s more likely to affect your legs.
• Sweet’s syndrome: An inflammatory skin condition marked by fever, painful skin lesions, and neutrophilic infiltration. Neutrophils are a type of white blood cell. 
• Rheumatoid neutrophilic dermatitis: Another skin inflammation condition that involves neutrophils. It often includes many red bumps on the forearms and hands.
• Interstitial granulomatous dermatitis: A condition characterized by granulomatous skin lesions. Granulomas are clusters of immune cells. The lesions can appear in a linear pattern on the trunk and limbs.
• Palisaded neutrophilic and granulomatous dermatitis (PNGD): A skin condition with tender red bumps, often in a symmetrical pattern on the arms, elbows, hands, and feet. 
• Rheumatoid nodules: Firm, round, or oval lumps that develop under the skin, usually around joints. These nodules are caused by inflammation and are often painless. In more severe cases, they can also affect the tendons or internal organs. 

What does an RA rash look like?

RA rashes can take on many shapes, colors, and severities. They can affect people of all ages, genders, and skin tones.

According to the 2017 clinical review referenced above, RA rashes can include: 

• tiny red or purple spots
• larger purple or red patches 
• blood-filled blisters
• areas of pale or white skin that appear thinned out compared to the surrounding skin
• wheals, which are raised, red, itchy, and often circular or irregularly shaped areas
• raised, red bumps, which can be filled with pus
• ulcers
• open sores or wounds
• red or pink inflamed areas
• grouped, raised red bumps in a linear or fence-like arrangement

In individuals with darker skin tones, the bumps or rashes may appear darker or lighter than the surrounding skin rather than red, pink, or purple. 

What are the symptoms of an RA rash?

The severity, appearance, and symptoms of an RA rash can vary from person to person. Often, RA rashes can be itchy and painful.

RA rashes may occur along with other RA symptoms. According to the Centers for Disease Control and Prevention (CDC), that can include: 

• fatigue and weakness
• joint stiffness
• fever
• pain and aching
• unintended weight loss

What are the treatments for the rashes?

The 2017 clinical review referenced above explains the best treatment for RA-related skin conditions depends on the type of rash. Treatment will often address the underlying RA rather than just the RA rash. 

Similarly, the best way to prevent an RA rash and other RA skin conditions will likely be to manage your RA condition.

Some RA and RA rash treatment options include: 

• Systemic glucocorticoids: These are a type of steroids that can reduce inflammation and pain in your whole body. Options include:
  • prednisone (Rayos, Sterapred, Deltasone)
  • methylprednisolone (Medrol) 
  • dexamethasone (Decadron, Hemady)
• Topical corticosteroids: You can apply this directly to the affected areas of your skin to reduce inflammation and improve your rash. Options include:
  • clobetasol (Cormax, Olux, Temovate)
  • fluicinonide (Vanos, Lidex, Fluovix) 
  • desoximetasone (Topicort)
• Disease-modifying antirheumatic (DMARD) drugs: These help slow the progression of RA and may improve symptoms like rashes. Options include:
  • methotrexate (Rheumatrex, Trexall)
  • hydroxychloroquine (Plaquenil)
  • sulfasalazine (Azulfidine)
  • leflunomide (Arava)
• Tumor necrosis factor alpha (TNF-α) inhibitors: These can help reduce inflammation by decreasing TNF-α, which your body produces to support inflammatory processes. Options include:
  • adalimumab (Humira) 
  • infliximab (Remicade)
  • certolizumab (Cimzia)
  • etanercept (Enbrel) 
  • golimumab (Simponi)

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It’s best to talk with a doctor for a personalized treatment plan. They may also recommend other rash treatments like ointments or creams to address your specific symptoms. 

What causes RA?

RA is an autoimmune disorder, meaning the immune system mistakenly perceives a threat to the immune system and reacts by attacking healthy tissues. 

No exact cause is known. However, a review from 2020 explains that certain factors may contribute to the development of RA: 

• family history and genetics
• smoking
• exposure to dust
• the health of your gut microbiome 
• aging

Summary

An RA rash is a skin condition that can occur in individuals with RA. 

It can manifest in many forms like ulcers, swollen bumps, or red, inflamed areas. It may be accompanied by other RA symptoms like fatigue and joint stiffness. 

Treatment of RA rashes often involves managing the underlying RA condition with medications. 

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