Other issues faced by myself and colleagues more experienced than me include callback hell, race conditions, NPM errors and debugging code (in hindsight, something like node-inspector would have come in handy [1]).
Why Elixir? Well, for me OTP makes writing async code much easier. Message passing between GenServers or other processes is effortless. Fault-tolerance is built into the platform, as processes can be supervised and respawned when they die. It is based on Erlang, released 30 years ago and used by many large companies and projects [2]. Also, writing it makes me genuinely happy. :)
I would consider Ruby mostly because I've had my hands in Rails apps and can make my way around them. I've also been blown away by many brilliant people I've met and worked with in the Ruby community.
[1] https://github.com/node-inspector/node-inspector
[2] https://en.wikipedia.org/wiki/Erlang_(programming_language)#...