Rheumatoid nodules are tissue collections that appear as knots or knob in the skin. They are often found in patients who suffer from rheumatoid arthritis (RA), and they can be present all over the body. However, they are more often seen over the bony prominences.
What are rheumatoid nodules?
Nodules are described as firm, non-tender that can grow as large as a walnut or a small pea. They develop in about 25% of RA patients and are commonly found at pressure points like the elbow, back of the forearm, and metacarpophalangeal joints. These are common in chronic arthritis, although they are also associated with joint deformity. Nodules are also found in other areas aside from bony prominences including the lungs, eyes, and blood vessels. They can also appear on the vocal cords causing hoarseness.
Nodules are not tender in themselves, but they can cause pain when they get in the way of nerves or blood vessels. They may cause limitations in movement as well as affect organ function when they block vessels that lead to the lungs or the heart. People with this condition may also experience fever, fatigue, and generally, do not feel well.
The condition affects people in different durations. For instance, it may last for several months or up to a year and more, and then disappears without doing any damage. Those who have the mild type or moderate form may experience occasional flares and remissions for some time. Those who have the active type of disease often experience the most discomfort. In this form, the symptoms are worse and they last longer, often for several years without any periods of remission. The severe form can lead to damage to the joints and disability.
Why rheumatoid nodules develop
The exact cause of rheumatoid nodules is not known, although nodules usually occur in patients with severe rheumatoid arthritis. Nearly, all persons affected with the nodules test positive for the presence of rheumatoid factor, an antibody that is present in the blood of people who suffer from rheumatoid arthritis. It is also seen in other forms of autoimmune disease.
With this kind of autoimmune disease, the person’s own immune system begins attacking the cells for an unknown reason. The white blood cells cause the inflammation of the synovium (a thin layer of tissue that lines the joint space) also known as synovitis. Synovitis causes pain, swelling, redness, and warmth. The synovium gets swollen, and from a thin layer becomes thicker than usual, resulting in joint pains.
As the condition progresses, the synovium attacks the bone in the joint and the cartilage, leading to their destruction. This could very well result in the weakening of the muscles around the joint. Because of this, the sufferer then experiences difficulty in moving because of joint pains and other symptoms of RA. Worse, the condition may progress to bone loss and be the cause of osteoporosis. It may also lead to anemia, a condition that is characterized by decreased production of RBC, or red blood cells. Certain conditions that may also arise from RA include pain in the neck, dry mouth and eyes. Inflammation can also occur affecting the sac that surrounds the heart, some blood vessels, or the lung’s lining.
Other factors that may increase the growth of RA nodules include cigarette smoking and use of methotrexate, a common RA drug.
Rheumatoid arthritis vs. other types of arthritis
Rheumatoid arthritis generally comes in a different pattern, which is symmetrical, unlike other types of arthritis. This means that if one of the knees is involved, the other is also affected. The disease also causes pain to joints in the wrist near the hand.
Factors that contribute to the formation of RA
Genetic factors
Studies have found that there are certain genes that aid in the development of this kind of disease known as RA. Several genes are checked to determine if the condition will develop and how serious the condition becomes when it appears.
Environmental factors
Experts say that environmental factors can serve as a trigger in persons who are already genetically susceptible to the development of this disease. However, it is highly unlikely that this trigger is infectious.
Hormonal factors
Women are prone to develop the condition compared to men. Breastfeeding has also been known to worsen the disease. Studies have shown that the use of contraceptive pills, which alter the body’s hormone levels, also affects the person’s chances of developing the disease.
Complications
The presence of rheumatoid nodules brings pain, limited joint mobility, and nerve damage. It also causes fistula formation and ulcerations.
Rheumatoid arthritis treatment
There are three types of medications used in the treatment of RA. These include non-steroidal anti-inflammatory agents (NSAIDS), corticosteroids, and anti-rheumatic drugs. Non-steroidal anti-inflammatory agents work by reducing the inflammation to decrease pain and improve locomotion. NSAIDs also have mild to moderate analgesic effects. Aspirin is the oldest class of NSAIDs given to patients for this purpose.
Corticosteroids are another class of drugs that come with anti-inflammatory and immunosuppressive activities. They can be given orally, through IV, or by injections. They can be used in patients who have conditions that are not responsive to NSAIDs. However, they can also be the source of unpleasant side effects that include weight gain and moon face.
Disease modifying anti-rheumatic drugs (DMARDS) are given to patients who have clear presence of joint and bone erosion. Methotrexate is the most popular drug in this class given to arthritis patients.