Rheumatoid nodulosis

Signs and symptoms

The classic description of rheumatoid nodulosis in adults is that it is a variation of rheumatoid arthritis (RA) that appears as a proliferation of subcutaneous nodules, frequently on the hands and feet, linked to palindromic rheumatism without loss of joint function and with minimal to no systemic symptoms.

Mechanism

There are numerous theories regarding the pathophysiology of nodules linked to RA, and none of them are entirely accepted. Some have hypothesised that minor local trauma to small blood vessels induces nodules by causing rheumatoid factor-containing immune complexes to pool. It is believed that these immune complexes cause the release of chemotactic factors by activating nearby macrophages. More macrophages are drawn in by this process, which ultimately results in the formation of granulomas with central necrosis. Some have proposed theories regarding the role of underlying vasculitis or genetic factors in the development of RA nodules.

Treatment

Generally, there is no need for treatment for the lesions; however, on rare occasions, nonsteroidal anti-inflammatory medications or intralesional corticosteroids may be necessary. In patients with severe local discomfort who are highly symptomatic, resection may be an option.

Epidemiology

About 20% of people with rheumatoid arthritis develop rheumatoid nodules, which are linked to more severe erosive disease in those patients. The nodules are more common in men, typically manifest in the fifth decade of life, and are primarily found on extensor surfaces like the backs of the fingers and elbows, though they can occur anywhere.

References

References

1. Rapini, Ronald P.. (2007). "Dermatology: 2-Volume Set". Mosby.
2. Ziff, Morris. (1990). "The rheumatoid nodule". Wiley.
3. (1953). "The vascularity of the early subcutaneous nodules of rheumatoid arthritis". Bull N Y Acad Med.
4. (November 11, 1978). "Genetic basis of rheumatoid disease: HLA antigens, disease manifestations, and toxic reactions to drugs.". BMJ.
5. (2019). "Rheumatoid Nodulosis in an Adult Patient Negative for Rheumatoid Factor". Elsevier BV.
6. Evangelisto, Amy. (2003). "Rheumatoid Nodulosis". Ovid Technologies (Wolters Kluwer Health).
7. García-Patos, Vicente. (2007). "Rheumatoid Nodule". Frontline Medical Communications, Inc..