Rheumatoid Nodules

A variety of symptoms can occur when suffering from rheumatoid arthritis. The sporadic yet chronic nature of the disease is that symptoms may come and go over time and manifest in different ways.

One of the most common skin-based symptoms of rheumatoid arthritis is the development of rheumatoid nodules. Rheumatoid nodules occur in about one-quarter of rheumatoid arthritis patients, both men and women. The severity of rheumatoid nodules can vary from patient to patient. Though nodules are generally not dangerous or debilitating, there are treatment options available should it become necessary to have them reduced or removed.

What are Rheumatoid Arthritis Nodules?

Rheumatoid nodules are firm, noticeable lumps that form underneath the skin of some rheumatoid arthritis patients. These lumps generally form on or near the base of the arthritic joints.

Typically, rheumatoid nodules appear in the following locations:

  • Fingers and knuckles
  • Elbows
  • Forearms
  • Knees
  • Backs of heels

Less commonly, nodules may form in the eyes, lungs and vocal cords. These are rare yet severe cases of rheumatoid nodules.

Rheumatoid nodules range in size and shape. Most nodules are a circular shape, however, sometimes they can be a linear shape. They can range from small and pea-sized to as large as a walnut. When rheumatoid nodules form in a cluster of tiny nodules these are referred to as micro-nodules. This severe, less common case of micro-nodules generally occurs around the arthritic finger joints.

Though nodules are firm or even doughy to the touch and don’t cause any feelings of tenderness, they can occasionally be painful. Painfulness typically occurs when flare-ups are active and the joints have become inflamed which can impact the nodules and area around the nodule.

Rheumatoid nodules are capable of moving around. Some nodules, however, form a connection with the tendons or tissue beneath the skin and in this case, the nodules remain in place.

What Causes Rheumatoid Nodules?

As of now, research doesn’t clearly indicate a specific cause of rheumatoid nodules and why exactly they develop in some patients and not in others. Given they generally form on extensor joints, rheumatoid nodules could be the result of repeated pressure on the affected joints over time. Some patients report that rheumatoid nodules can decrease in size or go away over time.

Rheumatoid arthritis patients who are bedridden, sometimes form rheumatoid nodules on the backs of their elbows, their legs, or even on their hips and sacrum. Sometimes rheumatoid nodules may even form on the scalp at the back of the head. These are all the pressure points of bedridden patients and so this is a likely cause of forming the nodules.

Are Rheumatoid Nodules a Health Concern?

For the most part, rheumatoid nodules do not cause severe pain for most patients and are not usually a health concern. However, on rare occasions the skin overtop of the nodule can become infected or ulcerated. This generally only occurs if there has been an excessive amount of pressure placed on the nodule. If nodules develop in sensitive areas, then increased pressure resulting in infection could be more likely to occur.

Rheumatoid nodules have been known to form in areas of the body that are not joint-related at all. One severe symptom of rheumatoid arthritis patients is the development of nodules in the eyes. This is the result of an autoimmune disorder that causes eye dryness and pain. It can eventually lead to forming rheumatoid nodules.

Though it is rare, rheumatoid nodules are capable of forming on the vocal cords and in the lungs. It is incredibly difficult to diagnose this because the symptoms are not visible and sometimes mimic other illness and symptoms. Occasionally nodules can form in the heart or other organs although these are rare cases as well.

Who Develops Rheumatoid Nodules?

Most commonly, rheumatoid nodules develop in patients who have already been living with rheumatoid arthritis for some time. They generally don’t precede other rheumatoid arthritis symptoms.

Research indicates that most cases of rheumatoid nodules are found in patients who possess the specific rheumatoid arthritis antibody known as the Rheumatoid Factor. Patients also taking the common rheumatoid arthritis treatment drug Methotrexate, have also reported more cases of rheumatoid nodules.

While rheumatoid nodules develop in many different patients, research has shown an increased likelihood of developing nodules in rheumatoid arthritis patients who smoke. The link between the smoking habit and the formation of rheumatoid nodules isn’t yet clear.

Accelerated Nodulosis

Accelerated nodulosis is a specific condition that occurs with rheumatoid nodules. Patients with accelerated nodulosis experience the formation of multiple nodules in a centralized location typically on the fingers and backs of the hands.

This is compared to the sporadic appearance of a few rheumatoid nodules that form in patients here and there. In many cases, physicians have found that accelerated rheumatoid nodulosis occurs in patients who are pursuing Methotrexate therapy.

How to Treat Rheumatoid Nodules

Specific treatment for rheumatoid nodules isn’t generally used. Because most nodules are only unsightly as opposed to debilitating, they aren’t usually aggressively treated. However, if nodules cause the skin to become infected or ulcerated, then treatment will be necessary.

When nodules form on the backs of heels or bottoms of the feet, it can debilitate the patient and limit their mobility. In these cases, it will also be necessary to seek treatment.

Certain disease-modifying antirheumatic drugs (DMARs) have been known to reduce the appearance of rheumatoid nodules. Other treatments like steroid injections can also help to decrease the size of rheumatoid nodules.

Some patients report that even after treatment or having their rheumatoid nodules removed, they do grow back. Unfortunately, the nature of the condition is that symptoms, including nodules do come and go.

Talk to your physician about the available treatment options that can reduce the size of rheumatoid nodules or even remove them.