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Rheumatoid Nodules – Guaranteed Indicators of Rheumatoid Arthritis

Updated on November 10, 2014
Rheumatoid Nodules on Back of Forearm
Rheumatoid Nodules on Back of Forearm

What are Rheumatoid Nodules?

Rheumatoid arthritis is a disease which appears to be an ordinary one. However like most of the diseases it has many facets of which rheumatoid nodules is one. Rheumatoid nodules which are not very common are lumps of varying sizes which appear under the skin of the joints of rheumatoid arthritis patients. They range in size from a pea to a lime, but usually they are not painful, though are unsightly. As they vary in size, they vary in number too. They may be single or multiple.

Rheumatoid Nodules on Finger Knuckles
Rheumatoid Nodules on Finger Knuckles

Which Patients Get Rheumatoid Nodules and Where?

Rheumatoid nodules occur generally on pressure points, such as elbow, or heels or finger knuckles. Very rarely they occur in internal organs too like lining of lungs. They are normally present in chronic active rheumatoid arthritis patients and denote worsening of the joints. Also they denote confirmed presence of rheumatoid factor. The patients having rheumatoid nodules are more prone to other extra-articular manifestations of the disease too, like vasculitis. The nodules may occur rarely on eyelids, soles, and internal organs like lungs, gallbladder, valves in the heart, spine and larynx.

Rheumatoid Nodules on Elbow
Rheumatoid Nodules on Elbow

Complications

Rheumatoid nodules may be associated with complications like pain and reduced joint mobility. Sometimes they may be infected too because of ulceration. The infections may be local or distant due to hematogenous dispersal of bacteria.

Structure

These nodules are made up of dead tissue layering around a center. The nodules may have one or many centers depending upon their size. Between the outer layer and the center, there is a dense arrangement of macrophages and fibroblasts. There is also an area which contains T lymphocytes, plasma and blood vessels. This region between the center and the outer layer is called palisade.

Rheumatoid Nodules in Lungs
Rheumatoid Nodules in Lungs

Treatment

Surgical excision of rheumatoid nodules depends on many factors like their size, number, appearance, symptoms and existing treatment. Their size can be reduced with drugs which are included in the RA treatment. Some doctors experience that Hydroxychloriquine 200 mg twice in a day helps to decrease the size of the nodules. But drugs like tumor necrosis factor inhibitor drugs are ineffective on the nodules. And methotrexate even worsens them. When the nodules don’t respond to medicines, surgical excision can be an alternative. However patients should consider the chances of their recurrence. In many cases, these nodules may disappear after some time spontaneously.

Rheumatoid Nodules on Heels
Rheumatoid Nodules on Heels

Guaranteed Indicators of Rheumatoid Arthritis

Although rheumatoid nodules are ugly in their looks and sometimes even painful, they are helpful in confirming the presence of rheumatoid arthritis which is otherwise difficult to diagnose. Therefore when they occur, you can instantly start treatment for rheumatoid arthritis so as to avoid further worsening of the disease.

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    • Ruby H Rose profile image

      Maree Michael Martin 5 years ago from Northwest Washington on an Island

      Very helpful information, thank you!

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