RA and Skin Symptoms

Bones, joints and muscles
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Hey folks,

Wanted to say hello to you all today and just extend my sympathies to you with your condition.

I have an appointment tomorrow with a dermatologist for blood work and evaluation but I wanted to ask you about some of your symptoms that led to your diagnosis, in particular if any of you suffered from any type of skin abnormalities? In addition to the sequelae of other symptoms that accompany RA, I have been having one unusual one for the last few months. I have developed a bunch of microscopic red "flakes" that have appeared superficially on the skin. They are appear to be deep enough to where its sub epithelial but not quite endothelial to where I'd classify it has a type of purpura or petechiae. There are about 10-15 on my right arm, two on my knees and a few on my right knee and left foot. They are barely noticeable but they are there and they have not disappeared. In addition, I have been getting these unusual raised bumps that quickly turn into a pinpoint type of scab. Wondering if anyone with RA had any type of these symptoms leading to their diagnosis or after? Again, I am suffering the sequelae of events, I'm a 31 year old male in the US, but also under a considerable amount of stress in medical school. Ironically, we are just about to approach the block on auto-immune disorders. Any help on your experiences would be appreciated and again wish you all the best.

- Glenn

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Since I was diagnosed I itch, itch & itch. Tinea versicola which is a fungus on the skin. It is exbasterated by a comprised immune system. It is easily treated but constantly comes back. Hope you get some answers, please let us know how you are doing.

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For 3 years prior to my RA diagnosis I had trouble with a facial rash which started by my eyes, moved up to the forehead and down one side of my neck. I was put on prednisone and it got better, but 2 weeks after I was off it it came back worse. I saw the dermatologist who gave me some kind of steroid cream to use on it, but never did any kind of skin scraping to figure out what it was. The cream didn't help. It was very miserable and didn't go away for 3 years. It would have varying degrees of redness and pain - which was a burning pain. I started doing some of my own research and found that I have eczema of the face. Yes, another autoimmune disease. I started taking sulfa supplements and have to be very careful of lotions and make up on my face. I use Cetaphil for eczema for lotion and same for face soap and this seems to have helped. It's been completely gone for 2 years until about 3 weeks ago when I started having itchy red skin by the eyes which is how it all started so I'm hoping I can get it under control again.I also have Hashimoto's since 2007, so this was #2 of now 3 autoimmune diseases. From what I have read from others here and other blogs, and sites it is very common for those of us with 1 autoimmune disease to end up with several more. I'm hoping this stops at 3 as the RA diagnosis about threw me into the mental hospital..not really, but its VERY mentally stressful to deal with this when you've been nothing but healthy and active your whole life only to be told you have an aggressive form of a very serious autoimmune disease. It is worsened by stress, so maybe your rash is autoimmune in nature? Please become a rheumatologist and find us all a cure :-) 

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    Hi Glenn

      Sorry to hear you are also dealing with RA.  You don't mention if you are on any medications which could possibly be contributung to the skin symptoms.   When I was on MTX a had a few unusual 'bumps' on my skin.   I showed primary care doc and she was unsure of what it was and suggested seeing my dermatologist.    MTX was stopped for other reasons and by time I saw derm. MD the skin was cleared 

     I have 3 autoimmune conditions and one is vitiligo so I already had a dermatologist I was seeing

    I hope your appt goes well and that your RA is soon well controlled with meds

and that you are able to complete your medical training on schedule.   Unfortunately many of us here have had trial and error with the RA meds.    Please let us know how you are doing in the future     

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Do you have a positive RA diagnoses.  

I have a negative RA diagnoses, and rheumo tells me I have psorasis arthiritis which is first cousin to RA or all but, interesting that I also come back negative for psorasis on genetic tests, but she tells me that doesn't mean I don't have it. 

I don't have a typical psorasis diagnoses, I just have it on my sweat margins of my hair line in scalp, and as long as I wash my hair every day with coal tar shampoo, its keeps it pretty well under control, Dad also had psorasis. so watch for family members as well.

I do have the occasional outbreak on my hands, mainly if I have used some very strong cleaning product, and some has splashed on my skin, and sometimes on forearms if exposed to certain cleaners, I know because I start to itch within minutes of exposure, likely to be a contact dermatitis though, and know to watch for it.  I have creams to settle angry itchy skin, betamethasone dipropionate cream.

Stress does not help psorasis at all, known to be a trigger, and my rheumo is always asking me what have been my stresses this 3 month period.

Almost got to the point she no longer asks, as she knows I have been suffering with my osteo arthirits of hips, and now knees, family curse, brother has just had knees replaced, uncle had both hips replaced, great aunt crippled with systemic arthiritis,  hips replaced two years ago now, husband with heart failure and not well, battling to keep him alive and upright.

I have to be his nurse, wife, driver, carer, Dr when necessary, advocate, many is the fight I have had with nurses and Dr's at the hospital to have them take notice of his rather different to the text book symptoms, no swollen ankles are rather unusual in a heart failure patient, but his weight can change kilo's within a few hours, I have to be the one identifying problems as they arise, even in the hospital, only a few weeks ago nurses refused to change his medication at my request, LFT's high, and they had him on panadol for pain and fever, and even weigh him when I visited and identified he was a long way into congestive heart failure, during a virus attack, NO i was told he's not, YES HE IS, get the duty Dr, 4 hours later I was proved right and medication adjusted and drip taken down, GRRRRRRR.  

My Rhemo laughed when I told her this story, WHAT STRESS, the hospital doing there best to kill him, not likely on my watch.

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Hi Glenn, I started with RA about 15 years ago after that I started with Urticaria don't know weather it's linked but wouldn't be surprised if it is.

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Hi All,

Glenn, curious to know how your dermatologist appointment went. I have been an RA patient for about 15 years. I think I have been on pretty much every RA drug going. I had to stop methotrexate injections because of liver issues and am now on inflectra (a bio-similar of Remicade) and have these infusions every 8 weeks. I also still take 2 plaquenil every day. Started inflectra in April 2016 and had to stop in Dec 2016 because I was scheduled for knee replacement surgery. Got my new knee in March 2017 and started back on inflectra in May. And can now say the inflectra is working. It was hard to tell for a long time because of the pain in my knee and elsewhere as my body tried to compensate for the crappy knee.

Now I have skin issues and don't know if it is inflectra related or RA related or something else completely unrelated. My rheumatologist says my RA is quiet right now and I would agree. I had those little reddish bumps that seemed to scab (and then disappear) on both my elbows and around my finger joints. A few on my knees once in a while. I called them my RA bumps and sometimes they hurt a bit until they broke and scabed. They seemed to trigger a flare up. I never did get a real name for them. I have not had any bumps since starting inflectra. But now get what appear to be small red pimples with a small white head on my face, neck and abdomen. They are hard, hot and hurt. Takes about a week to go away but each one leaves a red mark that very very slowly fades. These are not at all like my RA bumps. I also have a red rash around my eyes that burns and is being treated with steroid cream. Waiting now for an appointment with a dermatologist. So hope I get some answers and some relief. This has all started since my knee surgery and restart of inflectra infusions. So I am now concerned as to whether this is an inflectra reaction.

Hope a bit of this helps you, Glenn. And if anyone else is experiencing anything weird while on inflectra, I would love to hear about it. Thanks all.

Jane

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Hey folks,

I want to take a second and reach out to all of you for taking an interest in my situation and just responding to the length you have. I know many of you suffering significantly so I really do appreciate it. My heart is with every single one of you.

I just wanted to clarify and update you on my personal situation. First off, every lab test has been ran from rheumatology and there is nothing right now that indicates any type of AI situation nor (surprisingly) is there anything that "objectively" is would be causing any of the symptoms I have. Backing up here for a second, as a medical student, I have to keep faith in the art of what I am committing my entire life to and I have to believe that medicine as a whole does make sense, and the values ARE, the majority of the time, predictive of what is going on in the human body. With that said, I know there are many of you, especially with AI disease that "know", and I do believe you that there is just something off and that numbers can only tell so much. And for those of you, I completely feel for you. 

To be fair, I am not really sure what is going on with me at this point. I know I certainly do not feel how I did now a year ago and I know I certainly do not feel like a healthy 31 year old individual. With that said, stress does some unbelievably bizarre things to your body and it is not uncommon for your mind to play tricks on you in your second year of medical school. So, at this point, with the dermatological condition apparently being something completely unrelated that has since resolved, I will wait to see what happens.

I wish you all the absolute best and I really thank you for sharing your experiences. Rheumatology certainly is on my list of subspecialties (I know for a fact I am doing internal medicine as my scholarship dictates it and rheumatology is a fellowship of Internal) so hopefully one day I can expand the effort to help all of you. My thoughts and prayers are with you and your families. 

- Glenn

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A lovely message, thank you. 

​Very best wishes for your medical career and maybe one day we'll see you leading the way in the management of auto immune diseases. Especially in Rheumatology!

​Carol