The presence of rheumatoid arthritis doesn't always just mean swollen, painful joints. The autoimmune disease is an inflammatory condition, meaning it can wreak havoc on many parts of the body, including the skin. This can take the form of rheumatoid nodules, bumpy growths under the skin that usually occur near an arthritic joint.
Who gets rheumatoid nodules?
Up to one-quarter of those who have rheumatoid arthritis develop nodules. In fact, it's the most common manifestation of the disease other than stiff, painful joints. Most arthritis patients who get the nodules are men, and it tends to occur in people with more severe arthritis. People with nodules are almost invariably rheumatoid-factor positive and experience multiple complications from the disease.
I was just diagnosed and I have no nodules. Does that mean I'm in the clear?
Unfortunately, no. Rheumatoid nodules tend to develop some time after diagnosis. However, they sometimes can be the first signs of arthritis.
How do I know if I have rheumatoid nodules?
Pay attention if you notice firm, painless lumps developing near afflicted joints. They tend to be the same color as your skin and can be quite small (the size of a pencil eraser) or fairly large (the size of a small piece of fruit). Fingers, forearms, back, and heels are common locations, and nodules on the heels or palms can be uncomfortable.
What's the treatment for nodules?
Most doctors favor leaving them alone. Typically they're benign, although they can become infected or gangrenous. In that case, you'll want them surgically removed. Rarely, doctors will inject a steroid into or just below the nodule to reduce it. Nodules can occasionally grow in the lungs and, while these usually pose no problems, they may rupture and cause collapse of the lung. Sometimes methotrexate, the biologic agent used to treat many cases of rheumatoid arthritis, can itself cause small nodules to form (this happens in about 8 percent of patients). In that case, prednisone or other medications may shrink the nodules.
Sources:
National Rheumatoid Arthritis Society, www.nras.org.uk
New Zealand Dermatological Society Incorporated, www.dermnet.org.nz
