Rheumatoid arthritis (RA) is a disease wherein your joints become painfully inflamed, causing stiffness, swelling, and joint deformities. When you have RA, your body produces proteins called autoantibodies, which attack and damage your joints. One of these autoantibodies is called rheumatoid factor (RF). If you have symptoms that are suggestive of RA, your doctor may order a blood test to see if you have high levels of these autoantibodies in your blood, including RF.
Not all patients with RA have abnormal or high RF levels in their blood. However, many patients that do have a positive RF blood test have more severe RA symptoms. One of these symptoms is having rheumatoid nodules.
Rheumatoid nodules are firm bumps that develop under the skin of people with RA. Each nodule is made up of a collection of different types of blood cells surrounding a core of protein fibers. These nodules may be small, ranging from the size of a pea to a walnut. However, some rheumatoid nodules have been reported to grow very large, from fist-shaped bumps to covering almost the entire elbow.
Only twenty to thirty percent of RA patients have rheumatoid nodules. However, almost all RA patients that have a positive RF blood test develop rheumatoid nodules eventually. Most people have rheumatoid nodules show up on their body a year or more after being diagnosed with RA.
Where are rheumatoid nodules found?
Rheumatoid nodules usually appear in areas of the body called pressure points—that is, places where bone and skin easily press up against each other. These pressure points are:
- Elbows
- Heels
- Knuckles, wrists, or fingers
- Hips
- The back of your head
However, rheumatoid nodules can also be found in other places in the body that are not pressure points, such as the pads of your fingers or toes. Rheumatoid nodules may also develop on connective tissue near your muscles, such as your tendons or fascia. You may also develop rheumatoid nodules inside your body, such as on your vocal cords, your eyes, or in internal organs such as your heart, lungs, bladder, and brain.
What symptoms do rheumatoid nodules cause?
Rheumatoid nodules that grow on pressure points may be painless. However, if they grow large enough, they may interfere with the movement of your joints. Rheumatoid nodules may also press on nerves, causing pain or numbness. Rough clothing or other surfaces may rub against your rheumatoid nodules, which may cause the nodules to ulcerate (develop wounds). Ulcerated rheumatoid nodules are susceptible to infection.
Depending on which part of the body they grow, rheumatoid nodules may also cause other symptoms. Rheumatoid nodules that develop on tendons or fascia may cause difficulty with movement or muscle function. If rheumatoid nodules develop on your vocal cords, you may experience throat pain or hoarseness. More serious symptoms may develop if rheumatoid nodules grow in your internal organs, as the nodules may keep these organs from working properly.
What causes rheumatoid nodules to develop?
The exact reasons causing rheumatoid nodules to grow are not known. However, as mentioned above, rheumatoid factor plays an important role. An inflammatory process probably contributes to the progression of rheumatoid nodules. Constant trauma at pressure points may also lead to rheumatoid nodules developing over these areas. The rubbing of skin and bone against each other may cause small blood vessels to break and have immune complexes containing autoantibodies pool in that area.
Some chemicals or substances may increase your risk for developing rheumatoid nodules. Studies have shown that RA patients who smoke are more likely to have rheumatoid nodules. A medication for RA, called methotrexate, may also increase the chances of having rheumatoid nodules.
What is the treatment for rheumatoid nodules?
Small rheumatoid nodules that do not cause any symptoms do not need to be treated. However, if the nodules become very painful, interfere with movement, or become infected, they may have to be reduced in size or removed.
Disease modifying anti-rheumatic drugs (DMARDs) that you take for your RA may help in reducing the size of rheumatoid nodules. If a stronger treatment is needed, steroids may be injected into your rheumatoid nodule in order to decrease their size.
You may choose to have your rheumatoid nodules surgically removed if you find them unsightly. Surgical excision of your rheumatoid nodules is also an option for symptomatic nodules. However, rheumatoid nodules that develop over pressure points tend to grow back a few months after they are surgically removed. Still, even with this possibility of recurrence, surgery may be recommended by your doctor if the rheumatoid nodule is very big or disfiguring, or if the nodule is infected.
If you have RA, regular visits to your doctor are very important to monitor the progress of your disease. A regular check up will also allow your doctor to keep a close watch on your rheumatoid nodules if any develop. It is best to have your doctor know if your rheumatoid nodules increase in size or number. Any ulcers, wounds, or infections that develop over your rheumatoid nodules should also be reported to your doctor. Before opting for alternative treatments, it’s best to consult your doctor first for the best medication for RA nodules.