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2.1
Rheumatoid Nodule
Nodule Rheumatoid
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.

Images

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WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0

Presentation

presentation of a common disease ' Head and Neck, vol. 39, no. 1, pp. [ohsu.pure.elsevier.com]

We report two cases presenting with cord compression by a rheumatoid nodule who underwent surgical decompression with good recovery. [ncbi.nlm.nih.gov]

Immune System

  • Cervical Lymphadenopathy

    Ultrasound examination revealed a cystic lesion in the absence of cervical lymphadenopathy in a non-smoker. [ncbi.nlm.nih.gov]

    There was no axillary or cervical lymphadenopathy. A repeat tissue culture showed enterococcus spp. (rare). Blood cultures were not performed as the patient showed no signs of a systemic infection. A complete excision of the lesion was performed. [ispub.com]

Skin

  • Subcutaneous Nodule

    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]

    METHODS: Subcutaneous nodules excised from 10 patients with rheumatoid arthritis were examined. [ncbi.nlm.nih.gov]

    Altman RS, Caffrey PR (1964) Isolated subcutaneous rheumatic nodules. Pediatrics 34:869–872 Google Scholar 12. Mesara BW, Brody GL, Oberman HA (1966) “Pseudorheumatoid” subcutaneous nodules. Am J Clin Pathol 45:684–691 Google Scholar 13. [link.springer.com]

  • 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]

Face, Head & Neck

  • Neck Mass

    Four months later, the patient again complained of fullness in her neck and a mass was felt on physical examination. [jmedicalcasereports.com]

Workup

X-Ray

  • 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]

Microbiology

  • 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]

Other Pathologies

  • 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]

    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]

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]

Other treatments like steroid injections can also help to decrease the size of rheumatoid nodules. Some patients report that even after treatment or having their rheumatoid nodules removed, they do grow back. [rheumatoidarthritis.org]

Most nodules pose only a cosmetic problem and, therefore, direct treatment is not necessary. [rheumatoidarthritis.net]

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]

Force) Bangalore-560 007, $-7 Air Force Hospital, Kanpur, India Correspondence Address: (Dermatology & STD), Command Hospital (AF), Bangalore-560 007, India Rheumatoid nodules occur usually in advanced seropositive rheumatoid arthritis, signifying poor prognosis [ijdvl.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]

Etiology

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 is unknown, but autoimmune mechanisms have been implicated. [hon.ch]

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]

Cutaneous infection may be an etiological agent in the formation of rheumatoid nodules in a patient with known RA. [ispub.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]

Pathophysiology

Next: Pathophysiology of Rheumatoid Arthritis [hopkinsarthritis.org]

Pathophysiology The pathogenesis of RA is not completely understood. [emedicine.medscape.com]

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]

Prevent or delay significant joint damage and deformity. Prevent permanent disability. Improve quality of life. Medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction. [northshore.org]

“I wish we knew more, I wish we could prevent that from happening, but we just don’t know enough.” [healthcentral.com]

Symptoms will clear up in a few days after treatment but therapy may last weeks. [46] Steroids are tapered down to lower doses to help prevent relapse and prevent the body from going through steroid withdrawal. [wikihow.com]

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