Although not often noted among classic rheumatoid arthritis (RA) symptoms, skin problems including itching and rashes are often reported from RA patients. “Sometimes it feels like my skin is crawling,” Sarah H. told us on Facebook. “Other times I just itch. I’ve had a few rashes, and I now have bumps on my legs and arms.” Some patients we heard from described itching so severe, they dug holes in their skin. Ouch.
So, is itching considered a symptom of rheumatoid arthritis?
“Rashes are not commonly associated with RA, but ‘you don’t need a rash to itch,’” says rheumatologist Doug Roberts, MD, an assistant clinical professor of medicine at the University of California Davis Medical School. “This means that they are not being reported, or we are not considering it as an important but under-recognized symptom.” This could be the case: RA patient Nancy K. told us on Facebook that her rheumatologist never asks about itching.
But there are good reasons you may be itching or have a rash with RA. Some are directly related to the nature of the disease; others might have another cause.
Read on to find out why, and when to discuss your symptoms and treatment options with your rheumatologist or dermatologist.
Causes of Rheumatoid Arthritis Itching
Although many RA patients report severe itching, the cause might actually be another related issue, such as eczema, hives, or medication side effects. “There is not a clear association between rheumatoid arthritis specifically and urticaria [hives] or eczema,” says Erin Mary Bauer, MD, a rheumatologist with Virginia Mason Medical Center in Seattle. But you can have RA and chronic hives, or RA and eczema, at the same time.
According to the National Institutes of Health, people with the itchy skin rash eczema (atopic dermatitis) have an increased risk of developing other inflammatory conditions, including rheumatoid arthritis. Eczema causes scaly, red, irritated skin that itches severely. “It shows up initially as weeping blisters that itch like crazy,” Erin M. describes on Facebook. “They first appeared on my hands and arms, then my feet, legs, and scalp.”
“People with any autoimmune disease are at a higher risk for developing chronic urticaria [chronic hives] than the general population,” says Dr. Bauer. Although the relationship is strongest with thyroid-related diseases, research has indicated that those with chronic hives have a higher chance of having RA, too.
“I have a tendency to break out into hives,” Natasha G. told us on FB. “Oddly enough, when I first started having obvious RA symptoms, that was one of the problems I had. For weeks on end I would break out in hives at night that would disappear in the early morning.”
RA medications and itchy rashes
Often, it can be hard to tease out exactly what’s causing itching or rashes, Dr. Bauer says. “This is always the biggest issue for us when people develop a rash while on one of our medications: Is it from the medication, the underlying disease, or something completely unrelated?”
“If a patient with rheumatoid arthritis develops a measles-like rash, that would be a complication perhaps of a medication that they’re taking,” says dermatologist Joseph Jorizzo, MD, a professor of dermatology at Wake Forest University School of Medicine and Weill Cornell Medical College. This type of “drug rash” may occur with non-steroidal anti-inflammatory drugs (NSAIDs), Dr. Jorizzo says.
It’s also possible the medications you take for RA could make another skin condition worse. “Sixty percent of patients who have chronic hives are made worse by NSAIDs,” Dr. Jorizzo says.
In addition, “there are some case reports I found of people on TNFi biologics for their RA developing hive-type allergic reactions, but that would be related to the treatment and not the RA specifically,” Dr. Bauer says.
“I have a patient whom I started on MTX [methotrexate] about a month ago calling and complaining of itching,” Dr. Roberts says. “I’ll maybe hold the MTX and see if it makes a difference.”
On the other hand, stopping RA meds that may have also been helping skin conditions (even without you realizing it) can cause them to get worse. “Rheumatology medications can treat more than just rheumatoid arthritis. If they’re stopped suddenly skin diseases that were being suppressed by those medicines can flare severely,” Dr. Jorizzo says.
RA Itching or Psoriasis?
The itchy, rashy skin condition called psoriasis can lead to the autoimmune disease psoriatic arthritis (PsA), but this is different than the above-mentioned itching that may occur in RA patients.
However, making the correct diagnosis between RA and PsA can be difficult in some patients.
“It is not uncommon for people with psoriasis to be misdiagnosed with eczema when they actually have psoriasis, and thus end up with a diagnosis of rheumatoid arthritis plus eczema when they actually just have psoriatic arthritis,” Dr. Bauer says. “This is why it’s always helpful to have rashes looked at by a dermatologist, and when a biopsy can be very helpful.”
People with PsA will usually have a negative rheumatoid factor in their blood, an antibody that is usually — but not always — positive in people with RA. It is possible, however, to have RA without being positive for rheumatoid factor, a condition known as seronegative arthritis.
Rheumatoid Arthritis Itching: When It’s Vasculitis
The main type of rash directly associated with RA is vasculitis, an inflammation of the blood vessels.
“When the arthritis is not well controlled patients develop manifestations that come out of the joints onto organs such as the skin,” says Dr. Jorizzo. “The mildest form of rheumatoid vasculitis are small tender bumps on the fingers, little tiny mini black and blue marks.” Vasculitis can also affect larger blood vessels that produce black and blue marks on other sites such as the legs. These marks are the main symptom of this type of rheumatoid arthritis rash.
Unfortunately, vasculitis may signal that the disease is getting worse. If you notice these types of marks on your skin, call your doctor. In addition, RA can directly cause other skin problems such as ulcers or nodules in your joints, so if you develop those, contact your rheumatologist as well.
Treatment for RA Itching and Rashes
In the case of vasculitis, talk with your doctor about better management of the underlying disease, as in this case RA is the direct cause of the rash. “This tells the rheumatologist that the joint disease needs a more stable treatment program,” Dr. Jorizzo says.
For other skin itching and rashes, you may benefit from a topical steroid treatment or an oral antihistamine prescribed by your doctor. Some of the home remedies described by patients on our Facebook page (check with your doctor before trying any of these) include grape seed oil, lavender oil, keeping cool or soaking in cool water, Epsom salt baths, and creams including CeraVe or Tiger Balm.
The science is still emerging behind RA and itchy skin rashes, and more research is needed to investigate causes and appropriate treatments. If you have itching, rashes, or other skin issues along with your RA, it’s best to involve a dermatologist as part of your medical team to help diagnose and specifically treat them.
“I think that all of these conditions would do better with a dermatologist co-managing with the rheumatologist,” says Dr. Jorizzo.