What Is a Rheumatoid Nodule?

Rheumatoid nodules are round, painless nodules that appear next to joints (such as elbow joints) in patients with rheumatoid arthritis. In the center, there are collagen fiber necrosis (or cellulose-like necrosis), and there are phagocytic cells and fibroblasts arranged around the grid. Nodules can persist for weeks, months, or even years. Nodules in a few patients can soften, shrink, or even disappear. Rheumatoid nodules appearing in the heart, lungs, meninges, etc., often cause symptoms of the corresponding system. After the rheumatoid activity period, nodules can subside.

Basic Information

Visiting department

Division of Rheumatology

Common locations

Para-articular

Common causes

Often associated with high-value rheumatoid factors and HLA-DR4 (+)

Common symptoms

It is nodular, of different sizes, more closely against the bone surface, hard, difficult to move, no pain or tenderness, and symmetrically distributed

Causes of rheumatoid nodules and common diseases

Rheumatoid nodules often appear at the same time as severe rheumatoid arthritis, often suggesting that rheumatoid arthritis lesions are active. It is often related to high-value rheumatoid factor (+) and HLA-DR4 (+). It can occur in 15% ~ 20% of patients with RA, single or several, hard as rubber-like, no tenderness or only slight tenderness, and often appear symmetrically above and below the elbow joint, knee joint, and tendon of extremities. The occurrence of rheumatoid nodules in the visceral parts can often cause systemic symptoms. Occurrence in the heart muscle and heart valves can cause heart valve insufficiency. When the sclera is involved, it causes episcleritis, scleritis, softening or perforation of the sclera. Dural rheumatoid nodules can cause meningeal irritation.

Rheumatoid nodule examination

A rheumatoid arthritis patient's forearm extension, elbow humeral protuberance, as well as occipital, Achilles and other joint bulges, compression sites appear under the skin. The lesions are nodular in size and generally vary in diameter from a few millimeters to a few centimeters. They are closely attached to the bone surface, are hard, difficult to move, and have no pain or tenderness. They are symmetrically distributed.

Differential diagnosis of rheumatoid nodules

Benign nodules that need to be distinguished from rheumatoid sarcoidosis. Benign nodules are common in children or young people and are histologically consistent with progressive necrotic nodules in seropositive rheumatoid arthritis. Nodules are usually found in the subcutaneous tissues of the cheeks, scalp, hands, and feet. Rheumatoid nodules that occur in the lungs need to be distinguished from tuberculosis, fungal infections, and tumors.

Rheumatoid nodule treatment principles

Actively control the condition of rheumatoid arthritis, rheumatoid nodules can subside. The treatment of rheumatoid arthritis mainly includes non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs (DMARDs) to relieve the disease, glucocorticoids, biological agents and botanical drugs. Non-steroidal anti-inflammatory drugs include Le Song and Futalin, which are anti-inflammatory and analgesic, and can control the symptoms of rheumatoid arthritis. Anti-rheumatic drugs that alleviate the condition can significantly inhibit the joint erosion and damage of rheumatoid arthritis and the occurrence of joint deformities, and can be used for a long time, including methotrexate, hydroxychloroquine, sulfasalazine, penicillamine, and leflunomide Te and Elamode. Glucocorticoids are suitable for patients with systemic manifestations, overtreatment, and patients who have failed regular treatment. Biological agents can quickly inhibit the progression of the disease. Currently, TNF- inhibitors, interleukin-6 inhibitors, and CD20 monoclonal antibodies are commonly used. Can also be applied externally with Chinese medicine or take some soft and strong Sanjie, traditional Chinese medicine for blood circulation.