Tattoos and Arthritis

Eileen Davidson had a goal: to get 30 tattoos by the age of 30. But when she was diagnosed with rheumatoid arthritis at age 29 — just one tattoo shy of her goal — she had two initial questions for her doctor. One: “Can I still have children?” Two: “Can I still get tattoos?”

The arthritis advocate and blogger at Chronic Eileen knew that having an autoimmune disease made her more vulnerable to infection. She had other questions, such as whether her body could handle the healing process, whether getting inked would interfere with the biologic medication she takes for her RA, and if could she time her tattoos to avoid an RA flare.

Both Davidson’s rheumatologist and her rheumatology nurse gave her the go-ahead to continue to get tattoos. Giving your health care providers the heads’ up that this is something you want to do — and working with them to get tattoos safely — is important for anyone, but it’s especially key when you have an inflammatory form of arthritis or any disease that could affect your immune system or ability to heal and recover.

Eileen Tattoo

Tattoos and Arthritis: Understanding the Risks

“I’d never tell a patient that they can’t do something they really want to do [like getting a tattoo],” says Alexa Meara, MD, rheumatologist at The Ohio State University Wexner Medical Center in Columbus, Ohio. “For someone with RA, their risk of infection can be higher. When it comes to patients who want a tattoo, I recommend researching to find a clean, well-reviewed, and reputable place,” she says.

Here are some concerns that people with arthritis or related musculoskeletal pain need to think about before deciding to get a tattoo:

Infection Risk

Your risk of infection may be higher because of the very nature of having an autoimmune disease, as well as the immune-suppressing medications you may take to treat your arthritis.

One particular area of concern with infection is hepatitis C. However, you can avoid this risk by going to a place you trust. Research shows that the infection is not likely spread by going to a licensed, commercial tattooing facility, per the Centers for Disease Control and Prevention (CDC).

Risk of Psoriatic Arthritis Flares

Patients with psoriatic arthritis or psoriasis have an additional consideration to discuss with their medical team. In this case, the physical “trauma” of breaking the skin (which is what happens with tattoos) can trigger a PsA flare, says Dr. Meara. This is known as the Koebner phenomenon: It means that you’re more likely to develop psoriasis plaques at sites where the skin is irritated or damaged. This is a rare side effect and something you can’t really predict, says Dr. Meara, but you should be aware that it’s a possibility.

If you’ve ever had skin damage (such as cut or burn) that caused a psoriasis flare, you may be more likely to have such a reaction after getting a tattoo.

Issues with Stiffness/Pain During the Procedure

Keep in mind that you may need to keep still for a long period of time during the procedure. This could be more challenging for people with arthritis, who can have pain and stiffness in joints when they’re immobile. It’s important to let your tattoo artist know about your disease and your concerns. When selecting a tattoo artist, ask around and look for recommendations of people who will be sensitive to your health needs. You may need to take more frequent breaks during the procedure, for example.

Skin Reactions

Even if you don’t have psoriasis or psoriatic arthritis, people with other kinds of inflammatory may have more sensitive skin or skin that is prone to allergic reactions. It’s common to have rashes with rheumatoid arthritis, for example. You may want to ask about getting a patch test in advance of the tattoo to make sure you don’t have a bad reaction to the chemicals or dyes in the ink.

How to Get a Tattoo Safely with Arthritis

It’s up to you to work with your doctors and tattoo artist to develop a plan of action for your specific health needs and circumstances. Davidson made sure to clear with her doctors that she could still get tattooed while taking her medications.

Time it right

Davidson learned that the best time for her to get a tattoo is to wait two weeks after a biologic infusion before going in to get inked. (Ideally, that’s also two weeks before her next infusion.)

That doesn’t have to be your rule, though, because research doesn’t give any clear answers on the ideal timing of tattoos when you have an autoimmune condition.

“If you are on certain medications you may want to build in a buffer [before getting a tattoo], but I don’t know of any data surrounding the ideal timing,” says Dr. Meara. The important part is that you ask your doctor when it may be best to go in, given your medication, symptoms, and health history. Davidson also questioned the rheumatology nurse who administers the infusions, as well as the maker of the biologic she was taking.

Give yourself extra recovery time

You might also consider how your body will feel during the healing process. Whether or not you should build in additional time for recovery will be dependent on the individual, says Dr. Meara.

Ask about pain management options

Finally, let’s talk pain. “If you’re scared about the potential pain from a tattoo, know that that it’s temporary. Remember, you’re able to handle the pain of RA, which doesn’t go away,” says Davidson. You can safely apply an OTC lidocaine cream before the tattoo, says Dr. Meara, but she suggests consulting with your tattoo artist as well.

Pick the right tattoo parlor

Look for a licensed, registered tattoo parlor with best practices for sanitization and infection prevention.

Find an accommodating artist

It’s important to share with your tattoo artist that you have RA or another autoimmune condition. “I have built friendships with my tattoo artists. I’ve noticed that they’re accommodating to all sorts of people. If you’re uncomfortable, need a break, or have to move a bit because you’re stiff, tell them,” says Davidson. To avoid any surprises, she also warns having RA means she might swell more than the average client.

When It’s *Not* Safe to Get a Tattoo

Whether a tattoo is right for you is going to hinge on your own health circumstances, but there is a circumstance that should give you pause. “If you’re on a long-term steroid, it may be a bad idea [to get a tattoo] because wound healing is reduced when you’re on steroid medication,” says Dr. Meara. While she would still support a patient who wanted to tattoo at this time, she may urge them to wait until they’re off this kind of medication.

It’s also not a good idea to get a tattoo over a joint that is affected by arthritis or where you could develop arthritis in the future. There’s always the possibility that you could need injectable medication (such as steroids) or surgery on the joint, and having a tattoo covering the joint could make such procedures more complicated.

Eileen Tattoo

One additional consideration, says Davidson, is the time of year to get the tattoo. While you can safely get one in the summer, sweat and sun fades new ink, she says.

Ultimately, do your research, talk to your doctors, and don’t take the decision lightly. “Whether you have an autoimmune condition or not, you enter at your own risk,” says Dr. Meara.

It’s been more than four years since her RA diagnosis, and today Davidson has too many tattoos to count. She says that one of those she’s most proud of is the rheumatoid arthritis ribbon. “It’s my badge for this invisible illness. I don’t think the disease should stop us from living or self-expression,” she says.

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