By Dr Irwin Lim, Rheumatologist
It’s been a while since I’ve seen these many lumps on a rheumatoid arthritis (RA) patient.
He’s had not-so-well controlled RA for decades and just presented from St Elsewhere.
These lumps are rheumatoid nodules. There are firm and felt under the skin, usually close to joints, and often close to areas which get exposed to trauma for example the hands, knuckles, and elbows.
Often you can move the nodules but sometimes, the nodules are firmly connected to the tissues under the skin.
Rheumatoid nodules can also be found in areas distant from joints - the lungs, heart and other internal organs.
They can range in size, think a pea to a walnut. They can be painless but some people find them uncomfortable and irritating, particularly if they get bumped a lot.
Rheumatoid nodules are thought to be present in up to 20%-30% of RA patients, and are thought to be associated with more severe disease. Most patient with rheumatoid nodules have a positive rheumatoid factor (RF).
Smoking is thought to increase nodules. Methotrexate use has uncommonly been linked to increased development of rheumatoid nodules.
I don’t get to see these very often nowadays, certainly not in 20-30% of my RA patients. Maybe it’s because I get to see patients relatively early in their disease course or our treatments are more effective. I don’t know.
Happy to hear what you guys think.
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.