Rheumatoid Arthritis Nodules
Rheumatoid arthritis nodules are stiff, fleshy lumps that develop under the skin. They develop in the vicinity of the affected joints. They can range in size from that of a pea to that of a walnut. The chances of adult rheumatoid arthritis patients for developing these nodules are 20% to 35%. Many times, these nodules are moving. Otherwise they can be attached firmly with the tendons or fascia below the skin.
They occur at pressure points, such as, elbows, back of forearms, heels, knuckles, hands and fingers. They can also arise on the vocal cord and cause hoarseness of voice. Rheumatoid arthritis nodules generally develop in chronic active conditions of the disease and it is common that they are associated with increased joint deformity and grave extra-articular locations. Even they can develop in the heart, lungs and other inner organs.
The nodules may not be associated with pain or any other symptoms in many rheumatoid arthritis patients. But it is possible that in some patients, the nodules may give rise to pain. It is also possible that the nodules may interfere with the activities by putting pressure on the nerves and thus limiting movements. Sometimes the skin over the nodules may rupture and may create an open sore and may lead to infection. If they are on locations like toes or any part of the feet, they may rub with the shoe and cause irritation. The rheumatoid nodules occurring on heart or lungs may be more severe and interfere with the function of those organs.
These nodules normally occur in patients with rheumatoid arthritis in the severe stage. Almost all the rheumatoid arthritis patients who develop rheumatoid nodules test positive for rheumatoid factor. About 70% to 80% of RA patients are positive for rheumatoid factor. And according to studies, when the disease is associated with a positive rheumatoid factor test, the condition is more aggressive.
There are other factors too which may increase the chances of rheumatoid arthritis nodules. Studies show that cigarette smoking has in important involvement in developing the nodules. Methotrexate, the drug of choice of many doctors for the treatment of RA, is also said to have involvement in developing the nodules.
It is seen that some DMARDs, i.e. disease modifying antirheumatic drugs, can diminish the size of RA nodules. Methotrexate is an exception for this, as it can increase the size and number of nodules. If it is seen that the nodules are developed as a result of methotrexate treatment, the change in the treatment may help to reduce the development. But the change should be done cautiously and keeping in mind that the need differs with individual.
Glucocorticoids or steroids may also be injected to the patient and help in shrinking of the nodules.
Sometimes it becomes necessary to perform a surgery as the nodules may get infected or may give rise to severe symptoms. But the nodules, situated on an organ of repeated trauma, have the tendency of recurrence, that too in a few months. It is wise to meet your doctor regularly in order to avoid any serious consequences of the rheumatoid arthritis nodules.