Rheumatoid nodules refer to the small subcutaneous lumps that form in most patients with rheumatoid arthritis. Nodules are found in different parts of the body, like the elbow, back of the arm, fingers, hands, and knuckles. The nodules differ in size from a small pea to a large walnut. These nodules may be movable, tight, and non-movable. About 20% to 25% of the patients with rheumatoid arthritis will develop these nodules. These lumps are usually found in people with chronic, active forms of rheumatoid arthritis, and it is often associated with serious manifestations of the disease, including in the lungs, eyes, and blood vessels.
When nodules are formed on the vocal cords, it may cause hoarseness. They may also form in internal organs, like the lungs and heart. Many people with nodules may not have any pain or symptoms at all. If the nodules are formed near a nerve, applying pressure on them, it may affect movement and other activities. Nodules formed in the internal organs may affect the functioning of the organ. Those patients who are on bed rest may develop these nodules at the back and buttocks. In some cases, nodules are seen developing on the bridge of those who wear spectacles.
Nodules are found in patients with severe forms of rheumatoid arthritis. Some of the other factors that increase the chances of nodules include smoking and certain medications, like methotrexate. Methotrexate is a common drug used in the treatment of rheumatoid arthritis.
Some of the complications associated with rheumatoid nodules include:
- Joint ulceration
- Formation of fistula
Nodules are found to recur in areas where there is repeated trauma. Size of the nodules can be reduced by using internodular steroidal injections. Disease-modifying anti-rheumatic drugs are also recommended to reduce the size of these nodules. In many cases, those who are taking methotrexate to treat the disease may have an increased number and size of nodules. If nodules are formed due to the use of methotrexate, doctors may suggest a change in the medication to alleviate the problem of nodules.
If the nodules are infected, surgery may be recommended. Surgery is suggested if the nodules cause severe symptoms. One should take care not to drain or excise the nodules just for the betterment of appearance. Talk to your doctor to ensure that surgery is absolutely needed. These modalities may increase the chances of infections and recurrence or nodules.