Rheumatoid nodule

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Rheumatoid nodule
Micrograph of a rheumatoid nodule, showing the characteristic palisading granuloma with a core consisting of necrotic collagen and fibrin. H&E stain.
Specialty	Rheumatology

A rheumatoid nodule is a lump of tissue, or an area of swelling, that appears on the exterior of the skin usually around the olecranon (tip of the elbow) or the interphalangeal joints (finger knuckles), but can appear in other areas.^[1] There are four different types of rheumatoid nodules: subcutaneous rheumatoid nodules, cardiac nodules, pulmonary nodules, and central nervous systems nodules. These nodules occur almost exclusively in association with rheumatoid arthritis. Very rarely do rheumatoid nodules occur as rheumatoid nodulosis (multiple nodules on the hands or other areas) in the absence of rheumatoid arthritis. Rheumatoid nodules can also appear in areas of the body other than the skin. Less commonly they occur in the lining of the lungs or other internal organs. The occurrence of nodules in the lungs of miners exposed to silica dust was known as Caplan’s syndrome.^[2] Rarely, the nodules occur at diverse sites on body (e.g., upper eyelid, distal region of the soles of the feet, vulva, and internally in the gallbladder, lung, heart valves, larynx, and spine).^[3]

Rheumatoid nodules can vary in size from 2 mm to 5 cm and are usually rather firm to the touch. Quite often they are associated with synovial pockets or bursae. About 5% of people with rheumatoid arthritis have such nodules within two years of disease onset, and the cumulative prevalence is about 20–30%.^[4] Risk factors of developing rheumatoid nodules include as smoking and trauma to small vessels.^[5]

In the majority of the time, nodules are not painful or disabling in any way. They are usually more of an unsightly nuisance. However, rheumatoid nodules can become painful when infection or ulcers occur on the skin of the nodule. Some nodules may disappear over time, but other may grow larger, making nodular size difficult to predict.^[6]

Treatment of rheumatoid nodules can be quite difficult, but both surgical removal and injection of corticosteroids have shown good results.