Overview
A rheumatoid nodule is a round, painless nodule that appears next to a joint (e.g., elbow) in a person with rheumatoid arthritis. They have a central necrosis of collagen fibers (or fibrinoid necrosis) surrounded by a fenestrated arrangement of phagocytes and fibroblasts. The nodules may persist for weeks, months, or even years, and in a few patients, they may soften, shrink, or even disappear. Rheumatoid nodules appearing in the heart, lungs, meninges and other places often cause symptoms of the corresponding systems. After the active rheumatoid period, the nodules can subside.
Questions you may have
What are rheumatoid nodules?
Rheumatoid nodules are the more common extra-articular manifestation of rheumatoid arthritis, and belong to the more typical symptoms of rheumatoid arthritis.
Patients with rheumatoid nodules tend to be rheumatoid factor positive and active, and are more likely to be male, with a long history of heavy smoking.
Rheumatoid nodules can occur anywhere, but they are mostly located in the joint bulge and subcutaneous areas of pressure, such as the extension of the forearm and Achilles tendon. The nodules are round or oval in shape, varying in size from a few millimeters to several centimeters in diameter, hard, non-indurated, and symmetrically distributed. They may also involve all organs such as the heart, lungs, pleura, and eyes.
The presence of rheumatoid nodules suggests that rheumatoid arthritis is active and requires active treatment.
When rheumatoid nodules are present, it is recommended to seek medical attention, follow the doctor’s instructions for further examination, and carry out targeted treatment or therapy under the doctor’s guidance.
Causes
Rheumatoid nodules are often seen in conjunction with severe rheumatoid arthritis, often suggesting that the rheumatoid arthritis disease is in an active stage. Rheumatoid nodules are often associated with a high prevalence of rheumatoid factor (+) and HLA-DR4 (+). 15-20% of patients with RA may present with a single or several hard, rubbery nodules that are non-tender or only slightly tender, and often appear symmetrically under the skin of the elbow, above and below the knee, and on the tendons of the extremities. Rheumatoid nodules in visceral areas can often cause systemic symptoms, appearing in the heart myocardium, heart valves can lead to heart valve closure insufficiency. Involvement of the sclera causes scleral epiphora, scleritis, scleral softening or perforation. Rheumatoid nodules in the dura mater may cause meningeal irritation.
Examination
Rheumatoid arthritis patients have a morbid appearance under the skin on the extensor side of the forearm, the elbow humerus, and the occipital region, Achilles tendon, and other areas of joint prominence and compression. The lesions are nodular in shape, varying in size from several millimeters to several centimeters in diameter, mostly close to the bone surface, hard, immobile, painless or tender, and symmetrically distributed.
Differential diagnosis
Benign nodules are commonly seen in children or young adults and are histologically consistent with the progressive necrotic nodules of seropositive rheumatoid arthritis. Nodules are usually found in the subcutaneous tissue of the cheeks, scalp, hands, and feet. Rheumatoid nodules occurring in the lungs need to be differentiated from tuberculosis, fungal infections, and tumors.
Treatment principles
Rheumatoid nodules can subside if the condition of rheumatoid arthritis is actively controlled. Treatment of rheumatoid arthritis mainly includes non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), glucocorticosteroids, biologics, and botanicals. NSAIDs, including lexapro and voltaren, are anti-inflammatory, analgesic, and can control the symptoms of rheumatoid arthritis. Relieving anti-rheumatic drugs can significantly inhibit the joint erosion and destruction of rheumatoid arthritis, inhibit the appearance of joint deformity, and can be applied for a long period of time, including methotrexate, hydroxychloroquine, salicylsulphadiazine, penicillamine, leflunomide, and elamectin. Glucocorticosteroids are indicated for patients with systemic manifestations, over-treated patients, and patients who have failed regular treatment. Biologic agents can quickly inhibit disease progression. TNF-α inhibitors, interleukin-6 inhibitors, and CD20 monoclonal antibodies are commonly used. It can also be treated with external application of traditional Chinese medicine or taking some traditional Chinese medicines that soften and disperse knots, activate blood circulation and remove blood stasis.