Rheumatoid nodules are small, firm lumps that form subcutaneously near the affected joints in people with rheumatoid arthritis. About 25% to 35% of people with rheumatoid arthritis develop nodules in different parts of the body. These lumps are often connected to the skin through tendons or fascia. In some cases, they may be movable. They are most commonly found in the hands, elbows, knuckles, and fingers. In rare cases, the nodules may form in internal organs like the heart, trachea, lungs, muscles, and vocal cords, which leads to a hoarse voice.
In most cases, these nodules appear only during the later stages of rheumatoid arthritis. Nodules may manifest in single extremities near joints, or as clusters, ranging in size from 2mm to 5cm. Most nodules are circular in shape; however, they can also develop longitudinally. Nodules may be firm to the touch, but can also be movable. They are generally painless in nature, but can lead to complications like pain, reduced mobility of the joint, neuropathy, infection, and ulceration. Nodules found near internal organs, like the heart and lungs, may affect the organ’s functioning.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disorder in which a person’s immune system attacks his/her own body tissues by mistake. It is a chronic inflammatory problem that can affect other parts of the body, like the skin, eyes, heart, lungs, etc.
The damage caused by this condition is not like the damage caused by osteoarthritis. In this disorder, the lining of the joints is damaged, causing pain and inflammation that can gradually lead to bone erosion and joint deformity. Some of the symptoms of rheumatoid arthritis are:
- Tender and inflamed joints
- Weight loss
- Stiffness in joints (especially in the morning or after extended periods of inactivity).
The initial stage of rheumatoid arthritis affects smaller joints like the ones between the fingers, hands, toes, and feet. Gradually, this condition starts to affect other parts, like the wrists, knees, elbows, shoulders, hips, etc.
The inflammation caused by rheumatoid arthritis can have an adverse impact on other parts of the body as well. Even though there are new medications for treating RA, patients suffering from severe RA can still have physical disabilities.
Rheumatoid nodules are usually seen in patients with severe forms of arthritis. Chances of developing nodules are higher in people who are positive for rheumatoid factor and display all the classic symptoms of rheumatoid arthritis. Those who test positive for the rheumatoid factor also have a higher chance of developing aggressive forms of rheumatoid arthritis. Other factors that increase the risk of developing nodules include smoking and certain medications, like methotrexate. Genes may also be involved in the development of nodules; studies show that certain genetic makeups increase the risk of these lumps.
Disease-modifying anti-rheumatic drugs (DMARDs) are some of the most commonly prescribed medications to reduce the size of nodules. Doctors may recommend a change of medication if nodules are formed due to the use of methotrexate. Steroid injections are also used to reduce nodule size. Infection of nodules that causes severe symptoms may need to be surgically removed. One should remember that these nodules should not be drained or injected by yourself as this can lead to a higher risk of infection and recurrence.
What Are the Causes of Rheumatoid Nodules?
Rheumatoid nodules are mostly observed in patients who suffer from severe rheumatoid arthritis and who have rheumatoid factor. Rheumatoid factor is an immune system substance found in the blood.
There is no clear reason as to what can cause rheumatoid nodules or why they only develop in certain people and not others. The fact that rheumatoid nodules are mostly formed on the extensor joints, like the hands, elbows, etc., could be because of the continuous pressure applied to these affected joints. There have been cases where a patient’s nodules become smaller in size and go away after a period of time.
Are Rheumatoid Nodules a Health Concern?
In most cases, rheumatoid nodules are not a health concern, and patients suffering from them do not experience severe, unbearable pain. However, in certain cases, the skin above the nodule may get infected. This is a rare condition that occurs when tremendous pressure is applied to the affected area. There is a greater chance of infection when the nodules develop in sensitive areas.
Rheumatoid nodules can form in any part of the body. Some patients suffering from severe rheumatoid arthritis can develop nodules in the eyes. This is due to an autoimmune condition that leads to dryness in the eyes, which can gradually cause rheumatoid nodules.
Rheumatoid nodules can also form in the vocal cords. This is a rare condition that is very difficult to diagnose since there may not be any visible symptoms or they may be similar to another medical condition. Other rare locations where rheumatoid nodules can form are the heart, lungs, and other organs. In such cases, they can cause health problems and severe pain in patients.
Who Is More at Risk of Developing Rheumatoid Nodules?
Rheumatoid nodules mostly form in individuals who already suffer from rheumatoid arthritis. In most cases, the nodules don’t show any signs before other symptoms of rheumatoid arthritis.
According to recent studies, rheumatoid nodules are mostly seen in patients who consume a particular medication for treating rheumatoid arthritis, known as Rheumatoid factor.
Other factors that can increase the chances of developing rheumatoid nodules are:
- Methotrexate (one of the commonly prescribed drugs for rheumatoid arthritis).
Accelerated nodulosis is a condition that crops up particularly with rheumatoid nodules. With this condition, patients develop multiple nodules in a specific location, usually the fingers and backside of the hands. In most cases, it has been observed to form in patients who are taking Methotrexate for rheumatoid arthritis.
How Can Rheumatoid Nodules Be Treated?
There is no specific treatment available for rheumatoid nodules. In most cases, these nodules are just mildly unsightly and pose no real health concerns. Therefore, rheumatoid nodules are not aggressively treated. However, in cases where they become infected or the patient suffers from severe symptoms, they will need to be surgically removed or treated through some other method.
Rheumatoid nodules can also form below the feet and on the heels, making it difficult to walk. There are certain DMARs (disease-modifying antirheumatic) drugs that are helpful in minimizing the appearance of rheumatoid nodules. However, some patients who take methotrexate, which is also a DMAR drug, develop more and/or larger nodules. In such a scenario, the doctor will have the patient immediately switch to an alternative drug.
Another available treatment for nodules is steroid injections, which are beneficial in reducing the size of the nodules.
However, in some patients, the nodules may grow back even after treatment. Unfortunately, nothing can be done to rectify this, since it is simply the nature of the nodules.
Consult your doctor about the available treatment options that can help reduce the size of your rheumatoid nodules or remove them completely. Based on the condition and severity of the problem, the doctor will be in a better position to suggest the right treatment.
- About 25% to 35% of people with rheumatoid arthritis develop nodules in different parts of the body.
- In most cases, these nodules appear only during the later stages of rheumatoid arthritis.
- Rheumatoid nodules are mostly observed in patients who suffer from severe rheumatoid arthritis and who have rheumatoid factor.