Rheumatoid Nodulosis

Abstract

Rheumatoid nodulosis is an entity that describes a particular variant of polyarthritis associated with early manifestations of palindromic rheumatism, radiologic subchondral bone cysts, and subcutaneous rheumatoid nodules. This study describes the clinical, radiologic, histologic, crystallographic, and laboratory findings, as well as the outcome in a group of 16 patients with rheumatoid nodulosis that were followed for a period of 1-12 years. Six of these patients had an aggressive course and developed classic erosive polyarticular rheumatoid arthritis, while the others continued having episodic arthritis without erosive disease. Seven patients had cholesterol crystals in olecranon bursae containing nodules. Second-line drugs used to control the articular manifestations did not improve the nodulosis, erosive, or cystic subchondral bone changes. Rheumatoid nodulosis mimics several other rheumatic diseases, and in about 40%, classic erosive rheumatoid arthritis develops. The presence of cholesterol crystals in rheumatoid nodules or affected bursae can increase the confusion with other crystal-induced arthritis, in particular, tophaceous monosodium urate gout or xanthomatosis.

A Seropositive Nodular Rheumatoid Polyarthritis without Arthritis: Does It Exist?

“…The absence of true arthritis in our observation could be due to a low systematic passage of corticoids inhaled in the long term by the patient. Our case report may be another observation of a different subset of rheumatoid arthritis such as rheumatoid nodulosis witch was described first by Bywaters in 1949, then individualized by Ginsberg in 1975 [4, 5]. …”

Cutaneous Manifestations of Rheumatoid Arthritis: Diagnosis and Treatment

“…Rheumatoid nodulosis is a variant of RA that is associated with palindromic rheumatism, subcutaneous rheumatoid nodules, radiologic subchondral bone cysts, and a generally benign clinical course (Table 1) [24]. On histology, it closely resembles true RNs and shows a pattern of palisading necrotic granulomas [18].…”

“…However, there have been rare cases where rheumatoid nodulosis presented as a form of RA, leading to severe joint damage over time [25]. The differential diagnosis for rheumatoid nodulosis is similar to that of true RNs and includes conditions such as necrobiosis lipoidica, rheumatic fever, sarcoidosis, systemic lupus erythematosus, subcutaneous granuloma annulare, and necrobiotic xanthogranuloma [24,29].…”