Got hives?
You might have rheumatoid arthritis.
Most people don’t associate skin conditions with RA, but in fact, the skin is one of the organs commonly affected by this inflammatory, autoimmune disorder, and individuals with RA can be prone to multiple skin disorders.
According to the website RheumatoidArthritis.org, rheumatoid nodules — lumps of fibrous tissue surrounding a core of necrotic, or dead, tissue that form just under the skin — are one of the most frequent skin-based manifestations of RA. They generally form on or near the base of the joints of the fingers and knuckles, elbows, forearms, knees, the backs of the heel and even the bottoms of the feet, and they can also form in the eyes, lungs and vocal cords, although this is rare and is typically seen in the most severe cases of the disease.
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Although no one knows exactly what causes rheumatoid nodules, smokers, people who have had RA for a long time and those who test positive for the RA antibody known as rheumatoid factor are at greatest risk of developing them. People taking the drug methotrexate also report more cases of rheumatoid nodules.
Ranging from pea-size to as large as a walnut, rheumatoid nodules are not generally tender to the touch, although they can be painful during RA flares, episodes of increased disease activity characterized by intensified joint pain and swelling and heightened fatigue. Nodules that appear on the backs of the heels or the bottoms of the feet can cause pain when walking.
Ulcers can sometimes form in the skin covering the nodules and they must be treated to prevent infection, but for the most part, rheumatoid nodules do not require treatment unless they are painful or interfere with mobility. Disease-modifying antirheumatic drugs and steroid injections can help diminish or eliminate rheumatoid nodules.
Other skin manifestations of RA include chronic hives, or urticaria. Studies have shown that up to 50 percent of all cases of chronic urticaria have a chronic immune component. Inflammation of the blood vessels in the skin, known as skin vasculitis, can be a complication of RA and may indicate that other blood vessels in the body are inflamed as well. And eczema, psoriasis, skin infections and rosacea have also been associated with RA.
Why and how RA and these skin diseases are related is a subject of research. One study found that drugs that block tumor necrosis factor — one of the inflammatory proteins that are elevated in people with RA — may play a role. In the study, 25 percent of people taking a TNF blocker, including adalimumab, infliximab and etanercept, visited a dermatologist because of a skin disorder, compared with only 13 percent of people not taking a TNF blocker.
A Danish study led by Dr. Alexander Egeberg, a dermatologist at the University of Copenhagen, also found that there may be a genetic link between rosacea and autoimmune diseases like celiac disease — in which people are unable to digest gluten — multiple sclerosis, Type 1 diabetes and RA.
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Rosacea is a common inflammatory skin disease that is typically characterized by red, ruddy skin of the face. It may also be accompanied by enlarged, visible blood vessels and pus-filled bumps. It can sometimes cause the skin of the nose to thicken, a condition called rhinophyma.
No one understands what causes rosacea, though physicians have long thought that it may have an autoimmune component. Rosacea occurs more than three times more often in women than men, which is a similar ratio seen in people with RA and other autoimmune disorders, and may lend support to the autoimmune theory.
The University of Copenhagen study found that women with rosacea were more than twice as likely to have a concurrent autoimmune disorder like RA than their rosacea-free counterparts. The same association was not seen in men, except in the case of RA. There was a significant association between men with rosacea and RA.
“Data suggest that there are shared genetic and environmental risk factors for rosacea and RA,” Egeberg says via email, adding that “the contribution of medication versus other risk factors remains unclear. There is a good chance that some of the association is due to medication,” he says. “TNF-inhibitors and oral corticosteroids are used to treat RA, and both have been associated with rosacea development.”
Given these associations, “it may be appropriate for rheumatologists to pay attention to rosacea in their RA patients, since it may be worsened by use of certain drugs,” Egeberg advises. “In addition, dermatologists may wish to refer patients with rosacea to a rheumatologist if they suspect the patient may have arthritis,” he says, adding this may be particularly relevant in people with rosacea who are not responding to typical treatments.
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Dr. Graeme Lipper, a dermatologist in Danbury, Connecticut, agrees. “It would be easy to screen patients with rosacea, especially women, for potential autoimmune symptoms by asking a few simple, targeted questions: ‘Do you get numbness and tingling or weakness in your hands? Gastrointestinal upset or diarrhea when you eat wheat or other sources of gluten? How about joint pain and stiffness?'” Lipper says.
Egeberg says that more research is necessary to understand the nature of the association between rosacea and autoimmune disorders like RA, noting that investigators in the U.S and Taiwan are continuing to study the issue.
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Got a Skin Condition? You May Have Rheumatoid Arthritis originally appeared on usnews.com
