Certain medications can cause a skin rash with rheumatoid arthritis. The brand names of medications that can trigger a skin rash are: Plaquenil, Rheumatrex, Trexall, Solganal, Myochrysine, and Arava.
There is another reason for rheumatoid skin rashes and it is a condition called rheumatoid vasculitis. It can be serious and usually occurs in people with severe rheumatoid arthritis.
What is Vaculitis?
Vasculitis attacks the vessels of the body. It can be triggered by conditions such as cancer, allergic reactions, and some autoimmune diseases like rheumatoid arthritis.
The vessels become inflamed and that can lead to thickened walls. It can cause constriction of the vessels and a lack of blood flow. Tissues become deprived of oxygen due to the lack blood and nutrients. The walls of the vessels can become weak causing aneurysms to form. The weakness in the wall of a vessel can rupture and become life threatening.
Rheumatoid vasculitis can be the result of another disease. It can appear anywhere on the skin and the eyes, but usually occurs on the extremities.
Most skin lesions appear as ulcers near the ankle but can occur on toes and fingers. The nature of rheumatoid arthritis is to attack healthy cells because of its auto-immune nature. It occurs like other arthritic symptoms, without reason.
Fever and weight loss often accompany a skin rash. Other rheumatoid symptoms appear such as the swollen joints, pain, and exhaustion. According to the Mayo Clinic, it is not clear why outbreaks of vasculitis occur, but the rheumatoid factor seems to be a trigger.
Diagnostic tests for vasculitis include blood and urine tests, ultrasound, CT scan and MRI. Angiogram and biopsy of the infected vessel are also used.
Blood tests may include erythrocyte sedimentation rate to see if inflammation is present. Red blood cells and protein are often present in the urine when diagnosing vasculitis.
Imaging tests can show if the aorta and its branches are affected and if any aneurysms are present. Angiograms can illustrate any inflammation in the vessels and the severity of the disease.
The Mayo Clinic lists medications as the primary course of treatment. Cortisteroids are given but do not always eliminate the symptoms. Medications used in rheumatoid arthritis to control the immune system are successful. The cytotoxic drugs attack the immune system cells that cause inflammation. Two brand name drugs in this category are Cytoxan and Imuran. Cellcept is a drug that is still being tested.
Infection, recurring ulcers, and organ damage can occur. For severe cases where the ulcers are not responding to medication and basic wound care, hyperbaric pressure and maggot therapy have been used with some success
Rheumatoid vasculitis can recur often or remain indefinitely. Continued treatment is necessary
Only a physician can diagnose vasculitis so early detection is important. Seek medical treatment when a rash first appears. If you have vasculitis, your physician will set a course of treatment. Discuss any reservations that you have about treatment with your physician and be sure to report any negative reactions to medication.
Mayo Clinic: Vasculitis
John Hopkins: Rheumatoid Vasculitis
Wound Care Information: Maggot Debridement Therapy
https://www.medicaledu.com/maggots.htm#Current status of maggot therapy