Rheumatoid Arthritis (RA)
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What Is Rheumatoid Arthritis Neuropathy?

What Is Rheumatoid Arthritis Neuropathy?
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Published on March 3, 2025
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Rheumatoid arthritis (RA) is a chronic autoimmune disorder that causes inflammation, pain, and stiffness in the joints. But RA is a systemic disease — it affects the whole body — and can damage various tissues and organs besides the joints, such as the heart, kidneys, lungs, digestive system, eyes, and skin.

The disorder can also affect the nervous system, leading to peripheral neuropathy — damage or dysfunction of the peripheral nerves, which are nerves external to the brain and spinal cord.

Neuropathy from RA can cause a range of sensory and motor symptoms, particularly in the hands and feet. It’s crucial to understand the symptoms, causes, and available treatments of RA neuropathy in order to manage this complex condition and improve your quality of life.

What Is Rheumatoid Arthritis Neuropathy?

Rheumatoid arthritis neuropathy occurs when inflammation or other factors related to RA affect the peripheral nervous system.

This system is made up of the nerves that lie outside the brain and spinal cord (the central nervous system), which are essential for relaying signals or information between the brain and the rest of the body.

There are three types of peripheral nerves, without which you wouldn’t be able to sense the world around you (sensory nerves), consciously move your body (motor nerves), or carry out unconscious bodily processes such as breathing or digesting food (autonomic nerves).

If you have RA, you have around a 50 percent chance of developing some degree of peripheral neuropathy. It is one of the most common complications of RA.

Unlike some other forms of peripheral neuropathy, such as diabetes-related neuropathy, it can be difficult to tell if you have RA neuropathy. This is because about 50 percent of people with RA neuropathy are asymptomatic. And if you have symptoms from RA neuropathy, they will likely resemble your arthritis symptoms, such as pain and numbness.

Most neuropathies affect all three types of nerve fibers, but RA neuropathy appears to be more selective.

Some studies suggest RA neuropathy most often affects both motor and sensory nerves (rather than one or the other), while others suggest sensory neuropathy is the most common type for people with RA.

Like other forms of neuropathy, RA neuropathy can be subclassified as:

  • Mononeuropathy, affecting just one nerve
  • Multiple mononeuropathy, affecting two or more individual nerves in different areas
  • Polyneuropathy, affecting many nerves

Carpal tunnel syndrome, a type of mononeuropathy, is a well-known form of RA neuropathy, affecting about 6 to 7 percent of people with RA.

Symptoms of Rheumatoid Arthritis Neuropathy

The symptoms of rheumatoid arthritis neuropathy can vary widely, depending on the type and severity of nerve involvement.

Common symptoms include:

  • Pins-and-needles sensations (numbness and tingling) in the fingers and toes
  • Burning, stabbing, or shooting pain in the hands and feet
  • Stiffness in the hands and feet and inability to move the toes and ankle upward
  • Muscle weakness
  • Loss of reflexes or coordination
  • Sensitivity to touch, including pain from even a gentle touch

  • Difficulty walking and maintaining balance
  • Feeling like you’re wearing invisible gloves or socks

  • Fainting
  • Cold, clammy, and discolored (blue) hands and feet
  • Palpitations
  • Lightheadedness when standing after sitting or lying down
  • Excess or lack of sweating

Symptoms may develop quickly over days or weeks, or they may develop slowly over years. They can range from mild to severe and are often worse at night. Some people experience chronic (constant) symptoms from RA neuropathy, while others have episodic (on and off) symptoms.

Causes of Rheumatoid Arthritis Neuropathy

There are several main causes of neuropathy in RA.

Entrapment The most common cause of RA neuropathy is entrapment, which occurs when RA inflammation compresses a nerve. This is the cause of carpal tunnel syndrome in RA — a nerve in your wrist gets compressed, causing numbness in your fingers and eventually wrist pain. Similarly, cubital tunnel syndrome occurs from entrapment of the ulnar nerve in the elbow, and tarsal tunnel syndrome occurs from entrapment of the tibial nerve in the inner leg near the ankle.

Rheumatoid Vasculitis Neuropathy can also develop from rheumatoid vasculitis — damage to the small vessels that supply blood to the nerves, typically from inflammation. Usually, the nerves in the hands and feet are affected, but vasculitis can lead to dysfunction in multiple nerves in the body. In rare cases, it may even affect the small vessels in the brain, leading to a stroke.

Drug Side Effects Some disease-modifying rheumatic drugs (DMARDs), which are used to slow the progression of RA, can also cause neuropathy. These include tumor necrosis factor-alpha inhibitors — such as adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel) — and leflunomide (Arava).

Diagnosis of Rheumatoid Arthritis Neuropathy

To see if you have RA neuropathy, your healthcare provider will assess your reflexes, coordination, balance, strength, and sensory system (such as your sensitivity to touch). But given that neuropathy in RA is often asymptomatic, other tests are needed for a diagnosis. These include:

  • Blood tests to determine other potential causes of nerve issues, such as vitamin deficiencies, electrolyte imbalances, and other conditions (for example, diabetes)
  • Analyses of your blood platelet, blood protein, and C-reactive protein levels, which can be risk factors for peripheral neuropathy
  • Tests to check your levels of antibodies associated with RA, including rheumatoid factor and anti-CCP

Your provider or neurologist will also conduct a series of tests to assess your nerve activity and damage, including:

  • Imaging tests such as MRI scans and ultrasounds
  • Nerve conduction studies, which measure how well and how fast your nerves transmit signals
  • Electromyography, or EMG, which measures the electrical signals in your muscles and nerves attached to the muscles, which can determine if a nerve is compressed
  • Biopsy of nerve tissue

Treatment Options for Rheumatoid Arthritis Neuropathy

Treatment of rheumatoid arthritis neuropathy involves management of the underlying RA while addressing nerve damage and symptoms, potentially allowing your nerves to heal and regrow. This usually involves a combination of conventional medications, pain management, and lifestyle modifications. You may need to work with a neurologist.

Conventional Medications

Various types of medications can help to ease the pain and symptoms of neuropathy, such as:

  • Over-the-counter pain-relievers like acetaminophen and nonsteroidal anti-inflammatory drugs like ibuprofen
  • Antiseizure medications, including gabapentin (Neurontin) and pregabalin (Lyrica)

  • Antidepressants, including selective serotonin and norepinephrine reuptake inhibitors like duloxetine (Cymbalta) and tricyclic antidepressants like amitriptyline (Elavil)

  • Corticosteroids
Your provider may also change the dosage or type of DMARD you are taking, especially if you are on one that can cause neuropathy.

Pain Management Strategies

Aside from oral medications, topical medications to ease pain or block nerve conduction — such as lidocaine patches or capsaicin cream, respectively — can help.

Other pain management strategies and tools include:

  • Meditation
  • Talk therapy
  • Transcutaneous electrical nerve stimulation (TENS)
  • Physical therapy
  • Hand or foot braces
  • Orthopedic shoes
  • Wrist splints
If you’re experiencing severe nerve pain, you may need surgery to ease the pressure on your affected nerve.

Lifestyle Modifications

Certain lifestyle modifications can help reduce pain and symptoms of neuropathy. These include:

  • A balanced diet — such as the Mediterranean diet — that is rich in lean protein like fish, healthy fats, nuts, fresh fruits and vegetables, and whole grains, which provide essential nutrients that support nerve health and function
  • An active lifestyle, especially incorporating low-impact activities like walking and swimming

  • No smoking

  • Hand and foot massages to improve circulation and stimulate nerves
  • No prolonged pressure on your nerves: avoid crossing your legs or leaning on your elbows for too long

  • Reduce or eliminate alcohol consumption, which can have a toxic effect on nerves

Complementary Therapies

Some people find some relief from chronic neuropathic pain with complementary therapies, such as:

  • Acupuncture
  • Massage
  • Tai chi
  • Yoga
  • Deep breathing and relaxation techniques

Emerging Treatments

Researchers are investigating many different avenues for treating neuropathy, such as the following. It’s worth noting, however, that these are not yet available for use.

  • Small molecule drugs that improve nerve repair and reduce pain
  • Specific antibodies that reduce pain and inflammation
  • Stem cell therapy to repair or regenerate damaged tissues
  • Platelet-rich plasma therapy
  • Nerve grafts and other types of tissue engineering
  • Therapy with proteins called nerve growth factors

The Takeaway

  • Rheumatoid arthritis can lead to a condition called peripheral neuropathy, affecting nerve function and causing symptoms like pain and numbness, commonly in the hands and feet.
  • Early recognition and intervention are key to halting the progression of neuropathy and allowing your damaged nerves to heal.
  • If you have RA neuropathy, work with your healthcare provider to devise a personalized treatment plan to reduce the pain and symptoms of neuropathy while addressing your underlying RA, helping to prevent further nerve damage.
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. Wu D et al. Systemic complications of rheumatoid arthritis: Focus on pathogenesis and treatment. Frontiers in Immunology. December 22, 2022.
  2. Rajeshwari B et al. Rheumatoid Neuropathy: A Brief Overview. Cureus. January 24, 2023.
  3. Peripheral Nervous System (PNS). Cleveland Clinic. May 25, 2022.
  4. Kaeley N et al. Prevalence and patterns of peripheral neuropathy in patients of rheumatoid arthritis. Journal of Family Medicine and Primary Care. January 8, 2019.
  5. Peripheral Neuropathy. National Institute of Neurological Disorders and Stroke.
  6. Piecyk ML et al. Neurological Manifestations of Rheumatoid Arthritis. UpToDate. October 19, 2023.
  7. What Is Peripheral Neuropathy. Autoimmune Association. November 20, 2024.
  8. Uzun ÇA et al. Comparison of the median and ulnar nerves of rheumatoid arthritis patients and healthy subjects by ultrasound. Archives of Rheumatology. October 21, 2022.
  9. Catanese L. Peripheral neuropathy: Causes, symptoms, treatment, and prevention. Harvard Health Publishing. August 19, 2024.
  10. Nerve Symptoms. Rheumatoidarthritis.net. February 3, 2021.
  11. Jones MR et al. Drug-Induced Peripheral Neuropathy: A Narrative Review. Current Clinical Pharmacology. April 15, 2020.
  12. V Menard. Rheumatoid Arthritis and Peripheral Neuropathy. myRAteam. April 8, 2021.
  13. Lifestyle Changes for Peripheral Neuropathy. NYU Langone Health.
  14. Peripheral Neuropathy. Johns Hopkins Medicine.
  15. Managing and Coping With Neuropathy. The Foundation for Peripheral Neuropathy.
  16. Alcohol. The Foundation for Peripheral Neuropathy.
  17. Pain Management and Treatments for PN. The Foundation for Peripheral Neuropathy.
  18. Latest Advancements in Peripheral Neuropathy Treatment. Regenerative Neuropathy. November 5, 2024.
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Beth Biggee, MD

Medical Reviewer

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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