From the Guidelines
Rheumatoid nodules are the most common cutaneous manifestation of Rheumatoid Arthritis (RA). These firm, subcutaneous lumps typically appear over bony prominences or pressure points, such as the elbows, fingers, or heels, and occur in about 20-30% of patients with RA, particularly those with more severe disease or positive rheumatoid factor 1.
Key Characteristics of Rheumatoid Nodules
- Size: Usually 2mm to 5cm in diameter
- Consistency: Firm and non-tender
- Location: Commonly found on extensor surfaces
- Composition: Consist of fibrous tissue and inflammatory cells As noted in the study published in the Mayo Clinic Proceedings 1, rheumatoid arthritis can develop in persons of any age, with the typical age at onset of about 55 years, and clinical features typically include symmetric polyarthritis with joint swelling, especially of the hands and feet.
Management of Rheumatoid Nodules
While the other options (livedo reticularis, leg ulcers, and vasculitis) can occur in patients with RA, they are not as specific or common as rheumatoid nodules. Treatment of rheumatoid nodules is generally not necessary unless they cause discomfort or interfere with joint function. Effective management of the underlying RA with disease-modifying antirheumatic drugs (DMARDs) like methotrexate or biologic agents can sometimes lead to regression of the nodules, as part of a comprehensive approach to managing this disease, which has been greatly altered by the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process 1.
From the Research
Cutaneous Manifestations of Rheumatoid Arthritis (RA)
- The most frequent cutaneous manifestation in RA patients is rheumatoid nodules, occurring in 20-30% of seropositive individuals 2, 3, 4, 5, 6
- Rheumatoid nodules are typically firm, painless, and located on pressure points such as the hands and elbows 2, 3, 4, 6
- Other skin conditions can complicate RA, notably palisaded neutrophilic granulomatous dermatitis (PNGD), which presents as erythematous papules or plaques, often pruritic and distributed symmetrically over extensor surfaces 2
Characteristics of Rheumatoid Nodules
- Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis 3, 4, 5, 6
- Classic rheumatoid nodules commonly occur in genetically predisposed patients with severe, seropositive arthritis 3
- Rheumatoid nodulosis is characterized by multiple rheumatoid nodules, recurrent joint symptoms with minimal clinical or radiologic involvement, and a benign clinical course 3
Diagnosis and Treatment of Rheumatoid Nodules
- Histopathological examination is crucial to establish the diagnosis of rheumatoid nodules 2, 5
- Treatment of rheumatoid nodules is often not necessary, unless patients are experiencing pain or there is interference of mechanical function 4, 6
- Treatment options for rheumatoid nodules include surgical excision, antirheumatic agents, or observation 4