Rheumatoid nodulosis is a cutaneous condition associated with

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

, characterized by the appearance of multiple

nodules Nodule may refer to: *Nodule (geology), a small rock or mineral cluster *Manganese nodule, a metallic concretion found on the seafloor *Nodule (medicine), a small aggregation of cells *Root nodule Root nodules are found on the roots of plants, p ...

, most often on the hands.

Signs and symptoms

The classic description of rheumatoid nodulosis in adults is that it is a variation of

(RA) that appears as a proliferation of subcutaneous

, frequently on the hands and feet, linked to palindromic rheumatism without loss of joint function and with minimal to no systemic symptoms.

Mechanism

There are numerous theories regarding the pathophysiology of

linked to RA, and none of them are entirely accepted. Some have hypothesised that minor local trauma to small blood vessels induces

by causing rheumatoid factor-containing immune complexes to pool. It is believed that these immune complexes cause the release of chemotactic factors by activating nearby

macrophages Macrophages (; abbreviated MPhi, φ, MΦ or MP) are a type of white blood cell of the innate immune system that engulf and digest pathogens, such as cancer cells, microbes, cellular debris and foreign substances, which do not have proteins that ...

. More

are drawn in by this process, which ultimately results in the formation of

granulomas A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such subst ...

with central

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

. Some have proposed theories regarding the role of underlying

vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...

or genetic factors in the development of RA nodules.

Treatment

Generally, there is no need for treatment for the lesions; however, on rare occasions, nonsteroidal anti-inflammatory medications or intralesional

corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invol ...

may be necessary. In patients with severe local discomfort who are highly symptomatic, resection may be an option.

Epidemiology

About 20% of people with

develop rheumatoid nodules, which are linked to more severe erosive disease in those patients. The nodules are more common in men, typically manifest in the fifth decade of life, and are primarily found on extensor surfaces like the backs of the fingers and elbows, though they can occur anywhere.

References

External links

{{Medical resources , ICD11 = {{ICD11, FA20.0 , ICD10 = {{ICD10, M06.3 , ICD10CM = , ICD9 = , ICDO = , OMIM = 180350 , MeshID = D012218 , DiseasesDB = , SNOMED CT = 402426007 , Curlie = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , PatientUK = , NCI = , GeneReviewsNBK = , GeneReviewsName = , NORD = , GARDNum = 9625 , GARDName = Rheumatoid nodulosis , RP = , AO = , WO = , OrthoInfo = , Orphanet = , Scholia = Q7320488 , OB = Connective tissue diseases