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Rheumatoid Nodule

The rheumatoid nodule is the most common extra-articular manifestation of rheumatoid arthritis. They occur in about 20 to 25% patients with rheumatoid arthritis. Rheumatoid nodules are usually situated near bony structures close to a joint and primarily located in the subcutaneous tissue.


Presentation

  • We report two cases presenting with cord compression by a rheumatoid nodule who underwent surgical decompression with good recovery.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To determine if dendritic antigen-presenting cells (DC) are present in rheumatoid nodules, as has been reported in the synovial lesions of rheumatoid arthritis.[ncbi.nlm.nih.gov]
  • Histologic proof is often required since pulmonary carcinoma can present an identical clinical and radiological pattern.[ncbi.nlm.nih.gov]
  • This case is about a 79-year-old woman with rheumatoid arthritis who was taking methotrexate and hydroxychloroquine, presenting with an enlarging left buccal submucosal mass.[ncbi.nlm.nih.gov]
  • We present the case of a rheumatoid nodule in the lower lip, which rarely presents with variations in the clinical manifestation, that occurred in a 48-year-old female patient with rheumatoid arthritis.[ncbi.nlm.nih.gov]
Mediastinal Lymphadenopathy
  • Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis.[ncbi.nlm.nih.gov]
  • Lung involvement in Wegener's granulomatosis may manifest as lung nodules, which are often cavitary, acinar shadows which may represent alveolar hemorrhage, mediastinal lymphadenopathy and pleural effusions.[casesjournal.biomedcentral.com]
Subcutaneous Nodule
  • METHODS: Subcutaneous nodules excised from 10 patients with rheumatoid arthritis were examined.[ncbi.nlm.nih.gov]
  • While subcutaneous nodules are very characteristic of rheumatoid arthritis and its variants, they are not quite pathognomonic. Rarely, they are found in the absence of rheumatoid disease, especially in lupus erythematosus and in healthy children.[ncbi.nlm.nih.gov]
  • Patients with rheumatoid arthritis may develop extra-articular subcutaneous nodules as part of the systemic disease or as initial manifestation.[ncbi.nlm.nih.gov]
  • Identical features were noted in the histological examination of the subcutaneous nodule. Usually, rheumatoid nodules occur in patients with active, long-standing rheumatoid arthritis (RA) with other extra-articular manifestations.[ncbi.nlm.nih.gov]
  • When present, the subcutaneous nodule was invariably associated with clinically active SLE. In the patient with polyarthritis the presence of periarticular subcutaneous nodules may be a hallmark of SLE as well as rheumatoid arthritis. FULL TEXT[annals.org]
Indurated Skin Lesion
  • We describe a 69-year-old woman with RA who presented initially with fever and an indurated skin lesion on the right thigh. Lobular panniculitis was diagnosed after biopsy and was then treated with prednisolone.[ncbi.nlm.nih.gov]
Neck Mass
  • View Article PubMed Google Scholar Kaprana A, Fountoulakis NE, Karatzanis A, Velegrakis AG: Suture granuloma presenting as a lateral neck mass. Otorhinolaryngologia - Head and Neck Surgery Issue. 2012, 48: 36-40.[jmedicalcasereports.com]
Meningism
  • They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the body We present the case of[ncbi.nlm.nih.gov]
  • They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the body [ 2 ].[doi.org]

Workup

Ground Glass Appearance
  • A CT scan of the chest revealed scattered ground-glass appearance with mild associated septal thickening in the periphery of both lung bases most suggestive for early or mild interstitial lung disease.[ncbi.nlm.nih.gov]
Pseudomonas
  • Pseudomonas aeruginosa and Enterobacter cloacae were recovered. The conventional treatment of calcaneal osteomyelitis relies on antibiotics and calcanectomy or foot amputation.[ncbi.nlm.nih.gov]
Fibrinoid Necrosis
  • Adjacent vessels showed inflammation and fibrinoid necrosis of their walls suggestive of a vasculitis. Awareness of the possibility of ulceration in rheumatoid nodules may facilitate diagnosis and avert unduly aggressive treatment.[ncbi.nlm.nih.gov]
  • The characteristic morphological finding of the granulomas was the presence of neutrophils and the absence of definite fibrinoid necrosis, which differed from the typical features of rheumatoid nodules previously described.[ncbi.nlm.nih.gov]
  • On microscopic examination, the lesion consisted of two distinct areas: a central area of fibrinoid necrosis, bordered by histiocytes in a palisaded arrangement, lymphocytes and a 0.4 cm thick peripheral area constituted by a combined small cell anaplastic[ncbi.nlm.nih.gov]
  • Histological examination of nodules shows that they consist of a shell of fibrous tissue surrounding a center of fibrinoid necrosis. Pea-sized nodules have one centre.[en.wikipedia.org]
  • Histologic Features: Palisading granulomas surrounding degenerative collagen ("necrobiosis") and fibrinoid necrosis, without mucin, within the deep dermis and subcutis Vasculitis may or may not be present. External Links:[dermpedia.org]
Pleural Adhesions
  • The most common pulmonary manifestations of RA are pleural adhesions, effusions, and fibrosing alveolitis [ 12 ], whereas necrobiotic nodules are rare.[ncbi.nlm.nih.gov]

Treatment

  • Less frequently, rheumatoid nodules present in patients with rheumatoid nodulosis, a variant of rheumatoid disease where the nodules themselves are the primary manifestation of the disease and surgical treatment is highly useful.[ncbi.nlm.nih.gov]
  • The conventional treatment of calcaneal osteomyelitis relies on antibiotics and calcanectomy or foot amputation. We used two appropriate antibiotics and monthly intravenous injections of 90 mg of pamidronate.[ncbi.nlm.nih.gov]
  • Awareness of the possibility of ulceration in rheumatoid nodules may facilitate diagnosis and avert unduly aggressive treatment.[ncbi.nlm.nih.gov]
  • Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis.[ncbi.nlm.nih.gov]
  • Current methods of treatment include a variety of antirheumatic agents, surgical excision, or observation. Treatment options for the rheumatoid nodule are limited, due in part to the highly variable nature of the nodule.[ncbi.nlm.nih.gov]

Prognosis

  • (Outcomes/Resolutions) The prognosis of Rheumatoid Nodules of Skin is generally excellent with adequate treatment However, the prognosis also depends upon the severity of underlying rheumatoid arthritis (or other conditions) Adequately treating the underlying[dovemed.com]
  • BACKGROUND: The specific aim of our study was neither prognosis nor long-term evaluation but focus on determining incidence of rheumatoid nodules (RN) in a large population of patients with rheumatoid arthritis (RA) on the coastline of Croatia (Dalmatia[ncbi.nlm.nih.gov]
  • In such individuals, the prognosis is guarded If pulmonary hypertension develops, then the prognosis can be worse, especially if the patient does not respond to treatment Note: The progression or resolution of Rheumatoid Nodules of Lung is not related[dovemed.com]
  • - Discussion: - RA may cause symptoms because of pressure and location; - nodules may be cosmetically unacceptable; - nodulosis occurs in 20-25% of patients with RA - associated with strong seropositivity; - implies aggressive disease with poor prognosis[wheelessonline.com]
  • Treatment and prognosis Their natural history follows an unpredictable course. These nodules may undergo cavitation, increase in size, or resolve spontaneously over time.[radiopaedia.org]

Etiology

  • Rheumatoid arthritis is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement.[ncbi.nlm.nih.gov]
  • We conclude that CNS nodules are a rare extraarticular feature of RA which, although often of uncertain clinical significance, should be considered as a possible etiology when neurologic dysfunction occurs in the RA patient.[ncbi.nlm.nih.gov]
  • Etiology of rheumatoid nodules remains unclear, but both vascular and external trauma, combined with pooling of rheumatoid immune complexes, likely lead to the formation of the nodule.[visualdx.com]
  • No evidence was found for gout, diabetes mellitus, viral or other infectious etiologies, hypercholesterolemia, or elevated triglycerides.[ncbi.nlm.nih.gov]
  • (Etiology) The causative factors of Rheumatoid Nodules of Skin development are not well known or understood It occurs in individuals with rheumatoid arthritis (RA).[dovemed.com]

Epidemiology

  • Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum 1997 ; 27 : 123 –40. Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL.[doi.org]
  • Epidemiology Clinical History Physical Examination Extra-Articular Disease Laboratory Tests Radiographic Findings Clinical Course Epidemiology Rheumatoid arthritis has a worldwide distribution with an estimated prevalence of 1 to 2%.[hopkinsarthritis.org]
  • Epidemiology/risk factors Although rheumatoid arthritis is more common in females, rheumatoid arthritis associated-ILD (RA-ILD) occurs more frequently in males, with a male to female ratio as high as 2:1 in some studies [ 7, 10 ].[err.ersjournals.com]
  • Epidemiology Worldwide, the annual incidence of RA is approximately 3 cases per 10,000 population, and the prevalence rate is approximately 1%, increasing with age and peaking between the ages of 35 and 50 years.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

Prevention

  • How can Rheumatoid Nodules of Skin be Prevented? Rheumatoid arthritis does not always lead to Rheumatoid Nodules of Skin and not all individuals with longstanding autoimmune disorders may be affected by this benign condition.[dovemed.com]
  • “I wish we knew more, I wish we could prevent that from happening, but we just don’t know enough.”[healthcentral.com]
  • Currently, there are no preventive methods reported for Rheumatoid Nodules of Lung.[dovemed.com]
  • […] nodules. 3 Rheumatoid nodules are clinical predictors of more severe arthritis, seropositivity, joint erosions, and rheumatoid vasculitis. 2 The presence of rheumatoid nodules often suggests a need for more aggressive treatment of the underlying RA to prevent[arthritisinsight.com]
  • A biologic would be less dangerous, plus dealing with the RA at the root level - preventing the nodules from forming in the first place. My advice - go back to your rheumie, and demand a biologic.[dailystrength.org]

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Last updated: 2019-06-28 11:41