How Rheumatoid Arthritis Affects the Skin

How Rheumatoid Arthritis Affects the Skin
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Published on June 30, 2025
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The hallmark symptoms of rheumatoid arthritis (RA) are painful, stiff, and swollen joints, but this autoimmune condition can damage other tissues and organs as well, including the body's largest organ — the skin.

Some medications used to treat RA symptoms and slow disease progression can also cause skin reactions.

Keep reading to understand how the same mechanisms that cause joint issues in RA can also affect your skin, and how to reduce your risk of serious complications.

Why RA Can Cause Nodules, Rashes, and Ulcers

In RA, your immune system goes into overdrive and attacks your joints. This creates uncontrolled inflammation that damages the cartilage in your joints and circulates throughout your body. Skin affected by inflammation in RA can develop the following problems.

Rheumatoid Nodules

About 20 to 30 percent of people with RA develop rheumatoid nodules under their skin. Nodules are firm lumps that can range from the size of a pea to the size of a walnut.

Rheumatoid nodules form when ongoing inflammation from rheumatoid arthritis damages tissue in one spot, usually near joints or pressure points. In response, the body builds a “lump” made of immune cells. At the center is a small area of dead tissue, surrounded by white blood cells that gather there to isolate the damage and prevent it from affecting nearby healthy tissue.

“In general, nodules tend to affect those with more severe RA and positive rheumatoid factor,” says Jonathan Greer, MD, a rheumatologist at Arthritis and Rheumatology Associates of Palm Beach in Florida.

Nodules usually appear over bony areas, including:

  • Elbows
  • Fingers
  • Forearms
  • Heels or near the Achilles tendon
  • Hips
  • Low back (the sacrum)
  • Scalp

In many cases, the nodules don’t cause symptoms or bother people from a cosmetic standpoint and can remain untreated, says Dr. Greer. Sometimes they go away on their own.

In other cases, the nodules can be painful and interfere with daily activities. Rarely, a nodule can cause compressive neuropathy, in which a nerve is squeezed by the nodule, causing numbness and tingling.

Symptomatic skin nodules can be treated with injections of a combination of a steroid and a pain reliever into the nodule. If this doesn’t help, or the nodules are causing complications like infections or severe pain, they may have to be surgically removed.

Your doctor may also adjust your medications to include disease-modifying drugs (DMARDS) and monoclonal antibodies, which can help regulate the immune system and reduce inflammation, thus reducing the likelihood that nodules will form.

Although it’s less common, nodules can also form in other places in the body, such as the lungs, eyes, and vocal cords.

Easy Bruising

RA can lead to a low platelet count, which can cause bruising of the skin and bleeding from the gums. Platelets are cells that help the blood clot in response to an injury.

Low platelet levels can also be caused by some arthritis medications. “If a person [with RA] has bruising all over their body, it could be due to a medicine causing low platelets or the disease itself,” Greer says.

People with RA who experience bruising or bleeding should talk to their provider so that the risks can be properly managed.

Palmar Erythema

Some people with RA develop a skin condition called palmar erythema, which causes symmetrical redness of the palms; the condition isn’t itchy or painful. In palmar erythema, the red area blanches, or turns white, when pressure is applied to the skin.

Rheumatoid Vasculitis

Rheumatoid vasculitis is a rare condition that occurs in less than 1 percent of people with RA.

Rheumatoid vasculitis occurs when inflammation of the small blood vessels in the skin causes the vessel walls to weaken. When blood vessels in the skin are damaged, they can’t deliver enough oxygen and nutrients to the tissue. That causes the skin to break down, leading to painful ulcers, especially on the lower legs or fingertips.

“Vasculitis can look different in different people,” says Greer. “The rash can appear as purplish spots or little pinpoints of red on the skin, and it can be itchy.

Typically, people who have rheumatoid vasculitis have very active disease that is not well-controlled, says Greer. It’s also most common in people who have had RA for many years, though in rare cases it can happen sooner.

Because vasculitis is a serious complication, it requires careful management, often with a combination of medications that includes steroids, immunosuppressants or biologics, angiotensin-converting enzyme (ACE) inhibitors, and in some cases, surgery.

Neutrophilic Dermatoses

Neutrophilic dermatoses are a group of skin conditions that occur as a result of white blood cells (called neutrophils) that flood the skin because of the body’s chronic inflammation. Symptoms of these conditions include purple nodules, papules, or plaques that can be painful.

The two most common forms of neutrophilic dermatoses that may develop in people with RA include:

  • Sweet syndrome: This causes sudden, tender skin lesions, usually in the upper part of the body, and often comes with a fever. This rash may enlarge to form plaques or blisters. It can be painful and burning, but is not itchy.
  • Pyoderma gangrenosum: This is a very serious and painful manifestation in which the skin develops ulcers, usually on the legs. If not treated promptly, the ulcers can become infected or progress to the point where underlying tendons or muscles are exposed.

Skin Symptoms Caused by RA Medications

Some drugs used to treat RA can have side effects that affect the skin in some of the same ways that the disease itself can.

RA medications that can cause bruising, bleeding, or rashes include:

  • Corticosteroids (like prednisone): Long-term steroid use can weaken the capillaries, causing skin to become thin, fragile, and more prone to bruising.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter drugs like ibuprofen (Tylenol) and naproxen (Aleve) can interfere with blood clotting, also making bruising more likely.
  • Methotrexate: Conventional DMARDS like methotrexate can cause a low platelet count, resulting in bruising and bleeding.

     Some people on methotrexate have a noticeable increase in the size and number of RA nodules; this is called accelerated nodulosis.

  • Biologic DMARDS: Monoclonal antibody medications in this class, including tocilizumab (Actemra)

     and adulimibab (Humira),

     for example, may cause itching, hives, and rash.

Typically, rashes are red, itchy, and all over the body. “It’s usually a pretty clear connection,” says Greer. [Someone] takes the medication, and within a day or two, they get a rash. It’s pretty easy to diagnose.”

Your doctor will likely change your medication regimen if a certain drug is causing a skin reaction.

When to Call Your Doctor

If you have RA and notice changes to your skin, especially new lumps, open sores, bruising, or rashes, bring them up with your doctor. Some skin symptoms are harmless, but others can be a sign that your RA is more active or that your treatment needs adjusting.

Rashes that are painful, spreading, or causing ulcers are potentially more serious and require immediate attention.

The Takeaway

  • Rheumatoid arthritis is a systemic autoimmune disease: The same immune response that causes joint pain and swelling can also lead to an immune response in the whole body, including the skin, presenting as nodules, ulcers, and rashes.
  • Some RA medications, such as steroids, biologics, and methotrexate, may also cause skin problems, like easy bruising or a rash.
  • Skin symptoms are typically manageable with the right combination of medications and care. You can protect your skin and overall health by keeping RA under control.
  • If you notice new skin changes, especially ones that are painful, spreading, or not healing, talk to your doctor.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Diaz MJ et al. Cutaneous Manifestations of Rheumatoid Arthritis: Diagnosis and Treatment. Journal of Personalized Medicine. October 10, 2023.
  2. Rheumatoid Nodules. UpToDate. January 3, 2024.
  3. Rheumatoid Nodules. Cleveland Clinic. January 13, 2025.
  4. Frank J. When Rheumatoid Arthritis Symptoms are Serious. Arthritis-health. August 25, 2021.
  5. 10 Arthritis Symptoms Not to Ignore. Arthritis Foundation.
  6. Palmar Erythema and Pruritis. American Academy of Asthma Allergy & Dermatology. May 8, 2023.
  7. Who Gets Rheumatoid Vasculitis? Arthritis Foundation.
  8. Clinical Manifestations and Diagnosis of Rheumatoid Vasculitis. UpToDate. April 2025.
  9. Vasculitis. Cleveland Clinic. August 17, 2023.
  10. Weiss EH et al. Neutrophilic Dermatoses: A Clinical Update. Current Dermatology Reports. March 16, 2022.
  11. Pasadyn SR et al. Cutaneous Adverse Effects of Biologic Medicines. Cleveland Clinic Journal of Medicine. May 2020.
  12. Babkor D et al. Tocilizumab-Induced Dermatosis in a Patient With Rheumatoid Arthritis. Cureus. December 26, 2022.
  13. Gerriets V et al. Tumor Necrosis Factor Inhibitors. StatPearls. July 3, 2023.
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Beth Biggee, MD

Medical Reviewer
Member of American College of Lifestyle Medicine, Castle Connolly Top Doctor

Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.

Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.

Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.

In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.

Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.

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Becky Upham, MA

Becky Upham

Author

Becky Upham has worked throughout the health and wellness world for over 25 years. She's been a race director, a team recruiter for the Leukemia and Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

Upham majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.

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