Rheumatoid Nodules

Abstract

Rheumatoid nodules are a common manifestation of rheumatoid arthritis. These lesions are often easily identified based on typical diagnostic features and characteristic locations. When biopsied, nodules have a characteristic histologic appearance. Uncommonly, rheumatoid nodules can occur in systemic locations. There is no evidence that systemic therapy treats underlying rheumatoid nodules. Paradoxically, methotrexate and possibly tumor necrosis factor inhibitors can increase nodule development. Treatment of rheumatoid nodules is often not necessary, unless patients are experiencing pain or there is interference of mechanical function. This review outlines the available data on and associations of rheumatoid nodules.

Nodulose pelo Uso de Metotrexato em Doente com Artrite Reumatoide

“…6,7,11 Apenas a suspensão dos fármacos causadores podem facilitar a remissão dos nódulos, mas estes podem reaparecer com reutilização de MTX. 6,12 A excisão cirúrgica e a infiltração com corticoide são descritas como alternativas terapêuticas. 1 Muita controvérsia existe sobre a suspensão de MTX, principalmente nos casos em que a artrite responde bem a esse tratamento.…”

Nodular rheumatoid arthritis resembling gout

“…If there is persisting diagnostic uncertainty, an excised nodule can be identified histologically. Rheumatoid nodules have a consistent histological appearance defined by a central area of fibrinoid necrosis surrounded by palisading CD68+macrophages enclosed by a granulation layer2 (figure 3). …”

“…Treatments of nodular rheumatoid arthritis include glucocorticoid injections to symptomatic nodules and managing rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDS) and biological agents such as etanercept and infliximab 2. Interestingly, methotrexate and several other DMARDS have been linked to accelerated nodulosis in some patients with rheumatoid nodules 1 2.…”

“…Interestingly, methotrexate and several other DMARDS have been linked to accelerated nodulosis in some patients with rheumatoid nodules 1 2. Additionally, antitumour necrosis factor agents such as etanercept have been implicated in cases of accelerated nodulosis1–3 and the development of new pulmonary nodules 2 3…”

A Large Rheumatoid Nodule Mimicking Hepatic Malignancy

“…Approximately 40% of patients with rheumatoid arthritis (RA) suffer from extra‐articular manifestations, including appearance of rheumatoid nodules. These are found predominantly along the extensor surfaces of the forearm and the elbow and, less often, in visceral organs …”