Rheumatoid Arthritis: Numbness and Tingling Causes and Relief

Rheumatoid arthritis (RA) can cause numbness and tingling. An inflammatory, autoimmune disease that mainly affects the joints, RA inflammation can spread to surrounding nerves, leading to pins-and-needles sensations.

Symptoms like numbness and tingling shouldn't be ignored. They can be a sign of nerve compression, nerve damage, and inflammation that indicates RA is worsening.

This article discusses the connection between rheumatoid arthritis and numbness and tingling and how to find relief.

Numbness and Tingling as a Symptom of RA

Numbness and tingling can either occur apart or together, depending on the conditions that cause them. Numbness is a loss of sensation in one or more parts of the body.

Tingling can be mild to severe and usually feels like a "pins and needles" sensation you may experience when your limbs are asleep. Tingling most commonly occurs in areas of the body, such as the arms, legs, hands, fingers, feet, or toes.

Symptoms of numbness and tingling in rheumatoid arthritis can vary based on the extent of damage or compression to nerves, but can include the following:

• Loss of sensation 
• Pins and needles
• Burning sensation
• Prickling feeling in the skin
• Muscle weakness
• Skin sensitivity

Causes of Numbness and Tingling in RA

When the inflammation of joints from rheumatoid arthritis affects nearby nerves, it can lead to nerve damage or compression that can result in symptoms of numbness and tingling.

Rheumatoid arthritis is an inflammatory, autoimmune condition that causes the body to create antibodies that attack healthy joints. This results in joint pain, inflammation, and swelling affecting the joints and surrounding ligaments and nerves.

Over time, cartilage breaks down, narrowing the space between bones, and joints can become unstable or stiff. In addition, the ligaments that connect bones to support joints also become inflamed, causing them to become lax and less able to provide support to the joints.

This can cause joints to shift out of proper alignment. If left untreated, rheumatoid arthritis can cause permanent and irreversible joint damage.

Related Nerve Disorders

Because of these inflammatory changes to joints and surrounding structures, several other conditions that affect parts of the nervous system are often linked with rheumatoid arthritis, including:

• Carpel tunnel syndrome
• Peripheral neuropathy
• Autonomic neuropathy
• Spinal cord compression
  

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve that passes through the wrist from the arm to the hand becomes compressed, resulting in numbness, tingling, and weakness in the fingers. The median nerve passes through the carpal tunnel that's formed from the carpal bones of the wrist and finger flexor tendons.

Because rheumatoid arthritis commonly affects the wrists, causing bone destruction and ligament laxity, the height of the carpal tunnel often becomes narrowed, causing increased pressure on the median nerve within the carpal tunnel.

Peripheral Neuropathy

Peripheral neuropathy results from damage to the peripheral nervous system that is made up of the many nerves of the body, including those of the arms and legs, that send signals to and from the brain and spinal cord.

Peripheral nerves transmit both sensory information, such as feelings of pressure, pain, and temperature, and motor function information to contract and relax muscles. The hands and feet are most commonly affected by peripheral neuropathy.

A small study investigating peripheral neuropathy in people with rheumatoid arthritis suggests that peripheral neuropathy can occur in up to one-third of people with the autoimmune condition and that the risk increases with age.

There are multiple causes of peripheral neuropathy that can result in nerve pain in the hands and feet in people with rheumatoid arthritis. These include:

• Nerve compression
• Drug toxicity
• Vasculitis
• Amyloidosis 

Medications used to treat RA can also cause neuropathy. In particular, tumor necrosis factor (TNF) inhibitors have been shown to increase the risk of peripheral neuropathy.

TNF inhibitors used to decrease inflammation in RA and other autoimmune conditions include:

• Cimzia (certolizumab pegol)
• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab) 
• Simponi (golimumab)

If you suspect numbness and tingling in your feet or hands are related to your medication, talk to your healthcare provider. Changing your medications may help.

Autonomic Neuropathy

Autonomic neuropathy occurs with damage to the nerves that control your internal organs.

While the exact cause underlying autonomic neuropathy in rheumatoid arthritis isn't fully known, circulating autoantibodies and increased inflammatory proteins are thought to damage the vagus nerve.

Autonomic neuropathy can cause paresthesia, or a burning or prickling feeling in the limbs, as well as numbness and tingling.

Spinal Cord Compression

Rheumatoid arthritis of the spine can cause inflammation and joint space narrowing within the spinal vertebrae, which can lead to spinal cord compression and result in nerve pain, weakness, numbness, and tingling.

If compression occurs in the cervical spine of the neck, symptoms are usually experienced in the arms, while if compression occurs in the lumbar spine of the low back, symptoms often occur in the legs. 

Treatments and Management of Numbness and Tingling

Regular physical activity and stretching can help improve joint mobility, increase flexibility, and decrease nerve compression to help treat numbness and tingling.

Specific muscles to focus on stretching to relieve muscle tightness and potential nerve compression include:

• Upper trapezius: The back of your neck to your shoulders
• Levator scapulae: The back and side of your neck
• Pectoralis major/minor: Your chest
• Wrist and finger flexors: Your hands
• Lumbar paraspinal: Your back
• Hip flexors: The point of connection between your legs and hips
• Piriformis: Your buttocks and lower spine
• Hamstrings: Your pelvis to the back of your thigh

Additionally, nerve glides, also called nerve flossing, can help decrease nerve tension and improve the mobility of nerves to help reduce compression. Nerve flossing can be used to target the following nerves:

• Median
• Radial 
• Ulnar 
• Sciatic

Treating peripheral neuropathy can depend on its underlying cause. Other times, treatment focuses on managing symptoms. Options for managing peripheral neuropathy include:

• Over-the-counter (OTC) pain medication like nonsteroidal anti-inflammatory medication (NSAIDs)
• Topical pain-relieving creams or lidocaine patches
• Prescription medication to reduce pain, relieve inflammation, and decrease nerve signals, including corticosteroids, Neurontin(gabapentin), opioids, selective serotonin reuptake inhibitors (SSRIs), and immunoglobulin therapy delivered intravenously through an IV
• Physical therapy to improve strength and range of motion
• Controlling blood sugar via diet, exercise, weight management, and medication
• Eating a healthy diet and correcting vitamin deficiencies 
• Wearing protective footwear
• Hand splinting for carpal tunnel syndrome 
• Surgical release to remove nerve entrapment
• Transcutaneous electrical nerve stimulation (TENS) for pain relief

When to See Your Healthcare Professional

Numbness and tingling can occur for a variety of different reasons, some more urgent than others.  It’s a good idea to seek your healthcare provider if your numbness and tingling: 

• Occurs for no obvious reason 
• Makes it hard to move
• Persists for more than a few hours 
• Occurs intermittently 
• Leads to a cold feeling 
• Leads to shooting pain in the affected and surrounding areas 

Rheumatoid vasculitis, an inflammation of the blood vessels, is a rare but serious complication of RA. It can cause numbness and tingling along with the following symptoms:

• Skin sores
• Purple bruises
• Muscle weakness
• Tingling and pain
• Eye redness
• Blurry vision
• Chest pain
• Abnormal heart rhythms

Early diagnosis can prevent serious complications. Call your healthcare provider immediately if you notice any of these symptoms.

Summary

Rheumatoid arthritis is an inflammatory autoimmune disease. In some cases, inflammation of the joints from rheumatoid arthritis can affect nearby nerves, leading to nerve damage or compression that can result in symptoms of numbness and tingling.

Regular physical activity and stretching can help improve joint mobility, increase flexibility, and decrease nerve compression to help treat numbness and tingling. Other healthy habits like following an anti-inflammatory diet and managing stress effectively can help reduce inflammation in the body.

Treatment for numbness and tingling from rheumatoid arthritis is reliant on managing the underlying cause of nerve compression. It can include physical therapy, OTC treatments, and prescription medication, to name a few.