Rheumatoid nodule in Adult
Alerts and Notices
SynopsisRheumatoid nodules are common cutaneous manifestations of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The characteristic rheumatoid nodule occurs in 20% of patients with RA and may be an indication of RA disease severity. The pathogenesis of rheumatoid nodules remains unclear, but vascular trauma and external trauma combined with accumulation of immune complexes likely lead to rheumatoid nodule formation. Rheumatoid nodules may also occur within internal organs such as the muscle, heart (including pericardial and endocardial tissues), and lungs. Visceral nodules may clinically mimic infections, malignancies, or other autoimmune / inflammatory processes. Pulmonary rheumatoid nodules can present with cavitations. Large pulmonary rheumatoid nodules can cause pneumothoraces, pleural effusions, and hemoptysis.
Patients affected with rheumatoid nodules will often have a high titer of rheumatoid factor. In addition, patients with RA who are positive for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) antibodies are more likely to develop rheumatoid nodules. However, patients with mild RA may also develop rheumatoid nodules, as may patients who have rheumatoid disease without significant joint involvement. Nodules can also precede the onset of clinically significant arthritis by a number of years.
Rheumatoid nodules may persist, enlarge, or spontaneously regress over time. Nodules on areas subject to pressure or trauma, such as the sacrum, have a greater tendency to ulcerate. Secondary infections of ulcerated rheumatoid nodules can lead to septic arthritis. Additional complications of rheumatoid nodules include pain, reduced joint mobility, and peripheral neuropathy.
In a poorly understood phenomenon, patients with RA treated with methotrexate and TNF-alpha inhibitors can experience an increase in the number and size of rheumatoid nodules.
M06.30 – Rheumatoid nodule, unspecified site
33719002 – Rheumatoid nodule
Differential Diagnosis & Pitfalls
- Subcutaneous granuloma annulare
- Tophaceous gout
- 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 (see cutaneous tuberculosis; tuberculin test will show a positive reaction, and associated signs of pulmonary or extrapulmonary disease will be present)
- Necrobiosis lipoidica
- Erythema elevatum diutinum
- Granulomatous infectious processes
- Granulomatosis with polyangiitis
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Rheumatoid nodule in Adult