How do rheumatoid nodules affect patients with rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Rheumatoid nodules occur in approximately 25% of patients with RA, but they occur in fewer than 10% of patients during the first year of the disease. These lesions are most commonly found on extensor surfaces or sites of frequent mechanical irritation.

The olecranon process, the proximal ulna, the back of the heel, the occiput, and the ischial tuberosities are common periosteal sites for rheumatoid nodule development. Nodules may also form in subcutaneous tissues of the fingers, in toe and heel pads, in tendons, and in viscera. Rheumatoid factor (RF) is almost invariably present in patients with rheumatoid nodules; the absence of RF suggests other diagnoses.

Frequently, there is a discrepancy between the level of articular inflammation and the progression of nodule formation. Patients with rheumatoid nodulosis have a great number of nodules, usually subcutaneous, and may have little active synovitis. In a similar fashion, patients whose articular inflammation responds well to treatment with methotrexate (MTX) may have a seemingly paradoxical rapid increase in the number of nodules.

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