Skin and upper airways in rheumatoid arthritis

Dr.Hardik Rathod

Rheumatoid arthritis mainly affects joints and can cause deformities but it can also affect skin and other organs like lungs, eyes, heart and so on.

• Skin is affected in many ways and it may not be due to arthritis itself, sometimes it may be associated with medicines that are used to treat rheumatoid arthritis.

• Upper airways include your nose, upper part of throat and bronchi. Infection in upper airways specially common cold is very common.

• Skin manifestations of arthritis

1. Rheumatoid nodules:

• The most common extra-articular manifestation of rheumatoid arthritis, affecting 35–40% of patients.
• Approximately 90% are positive for rheumatoid factor.
• They present as solitary or multiple skin-coloured nodules on sites of recurrent pressure or trauma such as the forearm, elbow, fingers, heels, and back, and range in size from pea to some centimetres big.

2. Rheumatoid vasculitis :

• Unusual complication of long-standing severe rheumatoid arthritis, typically involving small to medium sized vessels in any organ of the body.
• It can come as a rash and can form an ulcer which can get infected and complicate the disease process.

3. Other uncommon conditions:

• Skin atrophy
• Dry skin (Xerosis)
• Erythema nodosum
• Thick skin with Raynaud’s phenomenon if associated with scleroderma or Mixed connective tissue disorder.

4. Medicine related changes:

• Allergic skin reaction like urticaria and itching can occur with any medicines. If you are allergic to any medicines, kindly let your doctor know before starting the treatment.
• Easy bruising and ecchymosis patches in patients on high dose or on long term steroids

• Skin hyperpigmentation, darkening, hair fall, nail changes can occur cause of medicines. 
• These side effects does not occur in all patients and if you feel any of these, contact your doctor for solution. 

• Upper airway in rheumatoid arthritis:

1. Infections:

• Recurrent common cold and cough can occur.
• Both as a part of disease and also due to long term treatment.
• Dose not require specific treatment, contact your family doctor for same and no need to stop treatment for your arthritis.
• Acute pharyngitis, laryngitis can occur which are generally infective and responds to treatment well. 

2. Oral ulcers :

•  Ulcers in mouth can occur on inner side of lips, on tongue or palate and cheek mucosa.
•  Can be due to medicines also.
•  Sometimes recurrent and painful.

3. Hoarseness in voice

•  Arthritis and inflammation in cricoarytenoid joint can sometimes leads to hoarseness in voice.
•  Laryngitis due to GERD can sometimes also cause hoarseness and chronic dry cough.

Overall rheumatoid arthritis can effect your skin and upper airways in many ways but early diagnosis, early contact of your doctor and treatment can prevent you from any of these complications.