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Patients with rheumatoid arthritis, one of the common subtypes of arthritis, are more likely to develop rheumatoid nodules. These are the 14 things you should know about rheumatoid nodules if you have rheumatoid arthritis.

Arthritis, a disease characterized by inflammation of the joints, is composed of over a 100 different individual subtypes. The two most common subtypes of arthritis are osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disease, which means that it develops because the body’s immune system mistakenly recognizes its own healthy tissue as a foreign object and starts to attack it. Hence, patients with rheumatoid arthritis have self-recognizing antibodies known as rheumatoid factor and anti-cyclic citrullinated peptides.

A variety of symptoms can develop in patients who suffer from rheumatoid arthritis. The primary symptom of rheumatoid arthritis is joint pain and swelling. However, some secondary symptoms include the development of rheumatoid or arthritis nodules.

Rheumatoid nodules are firm and/or doughy lumps under the skin. Generally, they develop either on or near the base of the arthritic joint.

Approximately a quarter of rheumatoid arthritis patients will develop rheumatoid nodules, making them one of the most common skin-based symptoms in patients with the disease. Rheumatoid nodules develop indiscriminately across all groups of patients including in all genders and across patients with all severity levels. However, the severity of rheumatoid nodules can vary from patient to patient.

Currently, it is not known exactly why patients develop rheumatoid nodules and why some people develop the disease over others. However, researchers believe that rheumatoid nodules develop due to repeated pressure on the affected joints over time.

Doctors don’t generally advise specific treatment for rheumatoid nodules, as they are generally simply unsightly as opposed to disabling or debilitating. Hence, they are usually not aggressively treated.

If you are a rheumatoid arthritis patient, these are the 14 things you should know about rheumatoid nodules:

  1. Rheumatoid nodules are more likely to develop in rheumatoid arthritis patients that present with more severe disease activity.
  2. Rheumatoid nodules are more likely to occur if your rheumatoid arthritis is extra-articular, which means that it affects body parts other than your joints (such as lung and blood vessels).
  3. Rheumatoid nodules can develop in various locations including the fingers, knuckles, elbows, forearms, knees and back of the heel. Rarely and in more severe cases, nodules can also develop in the eyes, lungs and vocal cords. Patients who are bedridden can develop rheumatoid nodules in the back of the elbow, legs, hips and sacrum.
  4. Rheumatoid nodules come in all different shapes and sizes. While most nodules appear to have a circular shape, others can be linear. Furthermore, their sizes are quite varied. While some can be as small as a pea, others can be as big as a walnut.
  5. Rheumatoid nodules can sometimes form a cluster of very small nodules called micro-nodules. These specifically tend to occur around finger joints that are arthritic.
  6. Generally, nodules are not tender or painful. However, in some cases, they may be painful if they are located near a nerve. If they do exhibit pain, it tends to occur when the patient is undergoing a flare-up and the joints become inflamed.
  7. Rheumatoid nodules can move around. However, they tend to stay in place because they form a connection with the tendons or tissue underneath the skin.
  8. Some patients with rheumatoid nodules experience a reduction in size or disappearance of rheumatoid nodules over time.
  9. Rheumatoid nodules are not generally a health concern. Rarely, the skin on top of the nodules can be become infected or ulcerated and will need to be treated. In this case, treatment for rheumatoid nodules will be necessary.
  10. Some studies suggest that rheumatoid nodules are commonly found in patients who have high levels of rheumatoid factor. Additionally, studies have shown that there is a higher correlation between patients with anti-cyclic citrullinated peptide antibodies and development of rheumatoid nodules.
  11. Some studies suggest that rheumatoid arthritis patients who are smokers have a higher likelihood of developing nodules, though the reason why there is a link between the two is unclear.
  12. Patients with rheumatoid nodules can sometimes develop accelerated nodulosis, a condition in which patients experience the formation of multiple nodules in one centralized region of the body. The back of the fingers and hands are commonly affected in this case. This often occurs in patients who are on the medication methotrexate. If you are on methotrexate and develop accelerated nodulosis, then your doctor will likely switch you to a different medicine.
  13. The use of certain disease-modifying anti-rheumatic drugs (DMARDs) can help reduce the appearance of rheumatoid nodules. Furthermore, steroid injections directly into the nodules can also help reduce the size of the nodules. Unfortunately, even after treatment, some patients report that the nodules grow back. They can also recur after treatment.
  14. In extreme cases, in which the lumps become infected or are causing severe symptoms such as inability to move your joint, you may need surgery to remove the nodules. Again, the nodules can still come back to the same spot after surgery.

  • Hurd, Eric R. "Extraarticular manifestations of rheumatoid arthritis." Seminars in arthritis and rheumatism. Vol. 8. No. 3. WB Saunders, 1979.
  • Nyhäll-Wåhlin, Britt-Marie, et al. "Smoking is a strong risk factor for rheumatoid nodules in early rheumatoid arthritis." Annals of the rheumatic diseases 65.5 (2006): 601-606.
  • García-Patos, Vicente. "Rheumatoid nodule." Seminars in cutaneous medicine and surgery. Vol. 26. No. 2. 2007.
  • Photo courtesy of SteadyHealth.

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