Rheumatoid Nodules: What they are, the risk factors, and potential treatments

What: Rheumatoid nodules are firm, skin-colored, subcutaneous rubbery bumps located on top of joints of rheumatoid arthritis patients. The nodules can often be pushed slightly from side to side although some nodules may be attached to deeper tissues.

They range in size from 1/8th of an inch (2mm) to greater than 2 inches (60 mm).

They are usually found on the extensor surfaces of the elbow (back of elbow joint), tendons involved in extending the elbow, hands, back part of the skull (occiput), heels, lower spine (sacrum) and bridge of the nose.

Rheumatoid nodules are granulomas which contain several unstructured layers of activated macrophages and T lymphocytes around the outside and a necrotic center of cellular debris, collagen, fibrils, and other proteins. Physicians often consider nodules as asymptomatic and generally of cosmetic concern. However, it would be nice to have normal looking joints.

Risk Factors

Patients with high Rheumatoid Factor titers and active inflammatory joint disease are more likely to develop rheumatoid arthritis nodules.

Rheumatoid arthritis nodules usually occur in RA patients with more severe disease.

Two studies found that smokers with RA were more likely to develop rheumatoid nodules than nonsmokers with RA (1, 2)

Potential treatments

Rheumatoid nodules may reduce in size during the regular treatment with DMARDs such as colchicine, hydroxychloroquine, and D-penicillamine.

If the nodule becomes infected, ulcerated, gangrene, or the underlying joint becomes stiff with limited range of motion, then more aggressive treatments are common. Surgical excision can be done, although it may regrow in the scar tissue.

Alternatively, the rheumatoid arthritis nodule may be injected with corticosteroid which usually reduces the swelling. However, infections and recurrence are possible side effects.

As I have begun to heal by providing essential nutrients, I’ve noticed that swollen nodule is shrinking.

Reducing your inflammation burden, or the amount of inflammation in your body, may help.

References:

1 Naranjo, A, Toloza, S, Guimaraes da Silveira, I, Lazovskis, J, Hetland, ML, Hamoud, H et al. Smokers and non smokers with rheumatoid arthritis have similar clinical status: data from the multinational QUEST-RA database. Clinical and experimental rheumatology 2010; 28, 820-7.

2 Papadopoulos, NG, Alamanos, Y, Voulgari, PV, Epagelis, EK, Tsifetaki, N,Drosos, AA. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clinical and experimental rheumatology 2005; 23, 861-6.

This information is not intended to diagnose, treat, or mitigate any disease. Consult your physician before making any changes to your medications or routine.

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