One of the symptoms associated with rheumatoid arthritis is the formation of enlarged soft tissues called nodules. Rheumatoid arthritis nodules are firm lumps made out of inflammatory tissue, which are skin-colored and commonly located near affected joints or at various pressure points. Around 20 to 35 percent of people who suffer from rheumatoid arthritis develop nodules, usually in cases where the disease is active and chronic. Males develop nodules more than females, and Caucasians have a higher likelihood to develop them compared to other ethnicities. One of the postulated causes of nodules in rheumatoid arthritis is the response to friction and pressure that result from the disease process. The nodules are commonly benign, painless, and unharmful; but clinical management tools are available to lessen the severity of symptoms when the nodules cause symptoms and heighten risks of other complications.
Rheumatoid arthritis’ disease process is mainly believed to cause the development of nodules, particularly the friction and weight pressure posed to the affected area. However, more research is necessary to further confirm, understand, and identify the factors that cause RA nodules.
Severe cases of rheumatoid arthritis is more commonly linked to the development of nodules compared to milder ones. Those who test positive for rheumatoid factor, an antibody that has links to inflammatory activity, commonly have nodules. Other risk factors that have been associated with the formation of RA nodules include cigarette smoking, and a commonly used drug to treat rheumatoid arthritis called Methotrexate has also been associated with increased nodule developments.
Clinical Features and Complications
The size of rheumatoid arthritis nodules vary depending on the course of the condition, which commonly ranges from being as small as a pea to being as large as a moth ball. The skin-colored nodules may be movable, or are firmly connected to fascia or tendons beneath the skin. They grow near affected joints or at several pressure points, such as fingers, heels, knuckles, hands, and elbows. In some cases, the nodules can also be found in vocal cords, the heart and lungs, tendons, and in other internal parts. The affected area can develop more than one RA nodule.
RA nodules are commonly benign, and bring no pain or other symptoms. However, these can also cause pain to the point of interfering with daily lifestyle activities. Some of the effects that may arise besides pain are limited mobility of joints, fistula formation, neuropathy, balance and gait abnormalities, and infection. Nodules located in internal organs may affect the respective organ’s functionality.
Because most nodules in rheumatoid arthritis are benign, physicians do not usually recommend employing treatment methods, unless these are confronted with complications and the presence of other symptoms.
DMARDS, or disease-modifying antirheumatic drugs, can be consumed to aid in reducing the size of nodules. However, caution must be taken when employing methotrexate treatment, because the drug can further increase the number and size of nodules. For larger ones, doctors may choose to inject the nodule with a particular medication, such as glucocorticoids. Surgery is another option if the nodule already causes complications and other symptoms like nerve pain and the presence of an open sore.