Rheumatoid nodule in Adult
These patients will have a moderate to high titer of rheumatoid factor. Sometimes, however, patients with mild rheumatoid arthritis may also develop nodules, as may patients who have rheumatoid disease without joint involvement. Nodules can also precede the onset of arthritis by a number of years.
Nodules on pressure areas such as the sacrum have a tendency to ulcerate. Subsequent secondary infection can lead to septicemia and septic arthritis. More complications of nodule formation are pain, reduced joint mobility, and neuropathy.
Nodules are composed of fibrous tissue with areas of fibrinoid necrosis, typically with palisaded granulomas in the deep dermis and subcutis. Nodules may stay the same size or grow larger. They may persist indefinitely or resolve spontaneously. Neuropathy and fistula formation are also known to occur.
This is a variant of rheumatoid disease in which nodules appear in the absence of synovitis. These nodules tend to be smaller than rheumatoid nodules and occur mostly on the hands and feet. After a number of years, rheumatoid nodulosis may convert to rheumatoid disease in which the joints are affected. Initiation of methotrexate therapy is a known trigger of nodulosis, especially on the hands.
Benign Rheumatoid Nodules
Nodules may sometimes be present in healthy young children in the absence of rheumatoid disease. The location of these nodules is different from those of typical rheumatoid nodules in that these occur mainly on the pretibial areas, feet, and scalp.
M06.30 – Rheumatoid nodule, unspecified site
33719002 – Rheumatoid nodule
- Subcutaneous granuloma annulare
- Calcium pyrophosphate deposition disease (pseudogout)
- Xanthoma, eg, xanthoma tendinosum (reveal foam cells on histology)
- Foreign body reaction
- Calcinosis cutis
- Myxoid cyst
- Mycobacterial infection (Mycobacterium marinum)
- Leukemia cutis
- Papulonecrotic tuberculid (tuberculin test will show a positive reaction, and associated signs of pulmonary or extra pulmonary disease will be present)
- Necrobiosis lipoidica
- Eosinophilic granulomatosis with polyangiitis
- Erythema elevatum diutinum
- Granulomatous infectious processes
- Granulomatosis with polyangiitis