Symptoms | What Members Say | Medications & Causes | Why It Happens | Duration | Management | When To Call a Doctor | Support

In rheumatoid arthritis (RA), the immune system mistakenly attacks the body, causing inflammation and damage in the joints and sometimes other tissues. People with RA commonly experience symptoms that affect their joints, skin, and eyes. Some people with RA — including many members of myRAteam — also report experiencing mouth and/or nose sores.

These mouth and nose sores aren’t caused directly by RA. In some cases, medications used for treating the condition are the culprit. These include disease-modifying antirheumatic drugs (DMARDs), some of which suppress the immune system, causing side effects including sores in the nose and mouth.

Additionally, certain other medications used to reduce RA symptoms and control flares — such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids — can cause mouth and nose sores. In other cases, people with RA may have unrelated conditions that result in mouth and nose sores.

If you’re living with RA and develop nose or mouth sores, speak with your doctor. They may be able to help you pinpoint the cause and figure out the best treatment.

Symptoms of Nose and Mouth Sores

Different types of mouth sores can present different symptoms, but people with mouth sores may experience the following:

• Blistering
• Pain, soreness, or discomfort eating spicy, salty, or hot foods
• Tingling or burning sensations
• Trouble chewing or swallowing
• A break in the skin or a surface of the mouth, tongue, or nose

What Do myRAteam Members Say About RA Medication and Sores?

Several members of myRAteam members have shared their experiences with mouth or nose sores as a medication side effect:

• “I was put on methotrexate last month, and my whole mouth is sore.”
• “Unfortunately, with the suppression from medication, it can cause blisters and sores. I used to get them all around my mouth. Now I just get them in my nose.”
• “I was wondering if anyone else has gotten roof-of-the-mouth and nostril sores. Not sure if it could be a side effect of medication or something else.”
• “I’ve been taking RA medication for five months and I have noticed almost constant canker sores and cold sores for the past four months. Has anyone else had this happen?”

Which Medications Cause Mouth and Nose Sores in RA?

Various RA medications can cause mouth and nose sores, as well as other types of side effects. Some side effects are common, while others are rare, and not everyone will experience every side effect associated with a medication.

If you have concerns about a potential side effect, always consult your health care provider. Do not discontinue a medication without a doctor’s approval. They may be able to recommend ways to manage the side effect.

Also, some drugs must be carefully tapered off rather than stopped abruptly to avoid withdrawal effects such as RA flares.

DMARDs

DMARDs are medications that modify the immune system by reducing or blocking chemicals related to inflammation. DMARDs have been proven to slow down the progress of RA and help prevent joint damage.

According to the Arthritis Foundation, there are three types of DMARDs:

• Conventional (or synthetic)
• Biologics
• Janus kinase (JAK) inhibitors

Conventional DMARDs

Conventional DMARDs are chemicals that modify the immune system in a broad way by suppressing it. DMARD medications include:

• Hydroxychloroquine (Plaquenil)
• Leflunomide (Arava)
• Methotrexate
• Sulfasalazine (Azulfidine)

These medications have the potential to cause oral and nasal sores as side effects due to their interactions with the immune system.

Biological DMARDs

Biologics, also known as monoclonal antibodies, are genetically engineered medications derived from cell proteins. Rather than suppressing the entire immune system, they target specific pathways.

Several, but not all, medications in this class can have the potential side effect of mouth and nasal sores. These include:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Rituximab (Rituxan)
• Ixekizumab (Taltz)

JAK Inhibitors

JAK inhibitors are a newer type of DMARD. They work by targeting specific immune system molecules that promote inflammation and modifying their activity.

Currently, three medications within this class are available:

• Baricitinib (Olumiant)
• Tofacitinib (Xeljanx)
• Upadacitinib (Rinvoq)

These medications could be associated with side effects, including cold sores or blisters inside the nose or on the lips. These may be due to taking methotrexate at the same time as the JAK inhibitors.

NSAIDs

NSAIDs do not treat RA itself, but they are commonly used to manage symptoms including pain, swelling, stiffness, and fevers. Most NSAIDs, including ibuprofen and naproxen, are available over-the-counter, but some must be prescribed. One prescription NSAID, Celebrex — a formulation of celecoxib — can cause ulcers or white spots in the mouth or on the lips. Cold sores or blisters on the lips or in the nose can also be a potential side effect.

Steroids

Steroid medications are used to treat RA flare-ups (also known as exacerbations). Steroids include prednisone, which can potentially cause dry mouth. Dry mouth raises the risk for mouth sores.

Why Do RA Medications Cause Side Effects Like Mouth and Nose Sores?

Immunosuppressive RA drugs change the way the immune system works. When a person’s immune system becomes less effective, they’re more susceptible to certain viruses, bacteria, or fungi. Before prescribing a new RA medication, a doctor will often run blood tests to look for evidence of infections.

Other Causes of Mouth or Nose Sores

If you have RA and mouth or nose sores, medications may not be the cause. Many common conditions can cause these symptoms.

• Oral thrush — This is an overgrowth of a fungus called Candida. The sores appear on the tongue, inside the cheeks, and on the tonsils and look like white bumps.
• Oral herpes (cold sores) — These can also occur as mouth sores and appear as clusters of small blisters on or around the lips.
• A weakened immune system — This can give rise to canker sores (or lesions) inside the mouth. These look like small cracks or reddish inflamed areas surrounded by a pale base.
• Actions of specific medicines — Methotrexate, for example, interferes with rapidly reproducing cells by blocking their access to vitamin B. This can result in sores. Your health care provider may recommend a folic acid (vitamin B) supplement to help with this situation.
• Sjögren’s syndrome — Among people who have RA, roughly 10 percent to 15 percent will develop a condition called Sjögren’s syndrome. This disorder causes dry mouth and can result in the person developing mouth ulcers.

How Long Do Sores Last?

Mouth and nose sores can last anywhere from 10 to 14 days but can sometimes persist up to six weeks.

How To Manage Mouth and Nose Sores

Not only can mouth and nose sores be bothersome; they can interfere with activities like eating and drinking. Members of myRAteam suggested several methods of dealing with these sores:

• “My doctor gave me a cream for nose sores. When I start to feel one coming up, I apply it like crazy as it does stop them.”
• “Saltwater is very soothing. I find the salt warm water the best to clear and heal inside the mouth.”
• “I use a mouthwash prescribed by my doctor, which helps.”
• “Try hard candies. One or two a day seems to keep the sores away.”

If you are experiencing issues in managing sores, talk to your health professional for medical advice.

When To Call Your Doctor

Consult your health care provider if you experience the following:

• Itchiness near or on the lips
• Sores that appear after beginning a medication
• Large white patches on the roof of your mouth or tongue
• Mouth sores that prevent you from taking your medication
• Constant runny nose or the appearance of nasal crusts or sores

Talk With Others Who Understand

On myRAteam — the social network for people with rheumatoid arthritis and their loved ones — more than 188,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Are you living with RA and mouth or nose sores? Have you found ways to manage them? Share in the comments below, or start a conversation by posting on your Activities page.