Rheumatoid nodules

Rheumatoid nodules accompany rheumatoid arthritis. Textbooks mention a rheumatoid nodulosis without arthritis, but my colleagues here and I have never seen someone with such a diagnosis. These nodules appear under the skin, often at extension sides of joints like elbow or finger knuckles. Sometimes these nodules are also seen in the lung. The Diagnosis can be confirmed by histological examination. It is unclear how the nodules develop. Methotrexate is associated with growth of nodules. With Rituximab sporadically one might see a reduction of nodules. Though most patients test positive for rheumatoid factor (M05.xx), rheumatoid nodules are classified like seronegative arthritis – M06.3x).



Here I show you some rheumatoid nodules of a patient, who recently appeared for a routine visit. Rheumatoid arthritis (ICD M05.80) started in 2003 and is currently treated with a combination of Leflunomide and Golimumab. Methotrexate can’t be used as he suffered from MTX induced pneumopathy. Last RF was 224 IU/ml. ESR 33 mm, CRP 26 mg/l.