Rheumatoid arthritis (RA) is a chronic but systematic form of arthritis. It results when the immune system of the body attacks the synovium, which is a joint lining. This is due to the creation of antibodies against the cells. With this, the joints are inflamed, become stiff, and may be destroyed.
RA will affect the body symmetrically, and it may also bring about other complications of the lungs, heart, or other organs. The severity of RA may range from mild discomfort to become completely debilitating. The presence of Rheumatoid arthritis nodules will usually signify more severity and destruction.
What are Rheumatoid Arthritis nodules?
Rheumatoid nodules are demarcated, firm masses or lumps that manifest under the skin. The nodules are made up of; Fibrin (a blood-clotting protein), inflammatory cells, and dead skin cells. RA nodules are occasionally painful and not tender, unless the overlying skin or nerves are inflamed, ulcerated, or impinged. They will typically not hurt unless they are close to a nerve or there is inflammation.
Rarely, the skin that overlies them becomes infected, or it may ulcerate. Suggestions imply that these nodules are now less incidental and that their occurrence has reduced, possibly due to a declining severity of RA. They are, however, common in patients that have embarked on methotrexate therapy. Methotrexate is a drug used for immune modulation. These patients will suffer what is termed accelerated nodulosis. Their rheumatologist must be conducted before discontinuation or adding different drug(s). Such patients will have micronodules (small and multiple nodules).
The nodules may not always bring about complications; however, if they are infected or irritated, mainly on high-pressure areas, there can be redness, a warm sensation, and swelling.
The sizes of these nodules and shapes are variable. They can range from around 2mm to 5cm. Some are round, and others take a linear shape. When touched, they feel firm or doughy.
Where can Rheumatoid Arthritis nodules form?
Typically, they will appear and be distributed in areas that suffer a lot of pressure or trauma repeatedly. They tend to be situated overexposed to joints like the elbows, forearms, wrists, feet, hands, fingers, or extensor surfaces. However, they may also occur elsewhere, like at the back of the heel, especially for bedridden patients.
RA nodules at the bottom of the feet can cause waking difficulties or pose gait abnormalities. They may also shift their stress and affect other joints causing lower back, hip, or knee pain.
Other areas that can be affected include the posterior scalp, hip, Achilles tendon, and sacrum. They can also establish a connection with tendons or tissues situated underneath the skin. For such cases, they may not move once pressed.
RA nodules can appear on internal organs in locations that are not even associated with any joint. For example, the sclera of the eye, vocal cords, and lungs. RA nodules will occur exclusively in almost all seropositive patients. This means those positive for the Rheumatoid Factor (RF), a RA positive marker.
Risk Factors of Rheumatoid Arthritis nodules
- Sex- Females are at a more considerable risk than males.
- Rheumatoid Arthritis period- the longer the time, the greater the risk.
- Smoking.
- Rheumatoid arthritis patients are at a higher risk.
- Heredity- Specific genes are associated with the risk of RA nodules.
- A high Rheumatoid factor (the blood proteins that are associated with autoimmune health disorders).
Diagnosis of Rheumatoid Arthritis nodules
Diagnosis is typically made based on historical RA positivity. A thorough exam is also conducted to reveal any nodules on the extensor surfaces. This will mostly apply if a patient has a high Rheumatoid factor titer. For most patients, arthritic symptoms precede the development of nodules. For a minimal number, the nodules may be present during the initial diagnosis.
Since other immune-mediated health conditions present themselves with lesions and, at times, similar histological appearance, the diagnosis is differentiated and extensive. It can include tophi caused by gout or pseudogout, basal cell carcinoma, epidermoid cysts, fibromas, and other lesion varieties. Physicians may do CT scans for asymptomatic nodules.
Treatment of Rheumatoid Arthritis nodules
It is not always necessary to treat RA nodules, mainly if they are a cosmetic concern. Symptomatic lesions will, however, need aggressive therapy or treatment. Such lesions cause pain, movement dysfunction, nerve impingement, infection, and/or ulceration. The treatment options include;
- The administration of disease-modifying antirheumatic drugs (DMARDs).
- Corticosteroids injections, for example, methylprednisolone, is very effective in reducing the nodule size. This may, however, raise the risk of infection.
- Surgery- Surgical nodule excision is done whereby the lesions have been infected, ulcerated, limit motion, entrap nerves, or limit one’s movement. Nodules subject to repeated trauma may need surgery. Nodules can recur even at the excision sites.
Final thoughts
Rheumatoid arthritis nodules will usually affect most Rheumatoid arthritis patients. They are, however, mostly benign, but they may cause physical limitations and deformity. It is therefore vital to collaborate with a physician or rheumatologist for a cause of treatment.
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