What is it?

Rheumatoid nodules are lumps found under the skin, close to joints, in people who have rheumatoid arthritis. Usually, these nodules do not hurt. Common locations include hands, fingers, knuckles and elbows. Nodules could also be found in the vocal cords, lungs and heart. Treatment is usually not necessary as they do not cause any symptoms or complications. DMARDS such as Rituximab can make it smaller.

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Differential diagnosis of rheumatoid nodules can be classified from localization, depth pathology, age of onset, persistence, rheumatoid factor, concomitant joint disease, and bone erosions. A rheumatologist typically determines diagnoses clinically. Rheumatoid arthritis associated rheumatoid nodules are typically subcutaneous and occur at extensor sites. The onset typically starts in adulthood and presents with rheumatoid factors, bone erosions, and concomitant joint diseases. The pathology is characterized by central necrosis, palisading mononuclear cells, and perivascular lymphocytic infiltrations.


Treating rheumatoid nodules is not always necessary, especially when they are a cosmetic concern. Symptomatic lesions, however, such as those infected, ulcerated, impinging on underlying nerves, or causing dysfunction due to location, deserve more aggressive therapy. This is particularly true if a patient is on immunosuppressive medications for their RA. Injection with corticosteroids such as methylprednisolone is one treatment option that is usually successful in decreasing the size of the nodules; however, an increased risk of infection or ulceration occurs with any injection. Surgical excision is indicated if lesions are already ulcerated, infected, entrapping peripheral nerves, limiting the range of motion, or in a location that incurs repeated trauma. Unfortunately, nodules often recur at sites of excision.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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