Rheumatoid nodules on a person's hand.
Rheumatoid nodules are small lumps that form underneath the skin near joints affected by rheumatoid arthritis.

What Are Rheumatoid Nodules?

Rheumatoid nodules are small, firm lumps that develop underneath the skin near joints affected by rheumatoid arthritis (RA). Rheumatoid nodules are unique to patients suffering from RA, and about one in every four people with RA develop these nodules. They are sometimes painful, but in many cases do not cause any problems unless they are very close to a nerve.

What Causes Rheumatoid Nodules?

While doctors know that rheumatoid arthritis is caused by an autoimmune response, doctors are not completely certain why rheumatoid nodules form in response to RA. Not all patients with RA get them, but those who do typically get them after they have had it for several years, suggesting it may take a long time for the nodules to form. There are some additional suggested risk factors:

  • Having an especially severe case of RA
  • Extra-articular disease (RA moving to other parts of the body than joints)
  • High levels of rheumatoid factor (an antibody present in the blood in RA patients that is used to test for the disease)
  • Trauma or injury to a pressure point

Rheumatoid nodules may even be triggered by certain arthritis medications, like methotrexate, in a condition called accelerated nodulosis. In these cases, nodules may appear on the feet, hands, or even the ears.

Symptoms of Rheumatoid Nodules

The most obvious symptom of rheumatoid nodules is their appearance. Rheumatoid nodules present as firm lumps that are clearly visible under the skin. They may resemble a ganglion cyst, but are generally firmer since a cyst contains liquid and a nodule is solid. Other symptoms of rheumatoid nodules include pain or discomfort in nodules, though this does not occur in all patients.

Rheumatoid nodules can be found individually or in small clusters, but in both cases, they are found close to one of the joints affected by rheumatoid arthritis, most commonly in the hands, heels and elbows. Nodules may also appear in areas like the back of the head, the hips and the tailbone in patients who are confined to bed. In some cases, nodules may even form on non-joint-related areas in the body like the:

  • Eyes
  • Vocal cords
  • Vulva
  • Gallbladder
  • Heart valves
  • Spine

In rare cases, rheumatoid nodules may form in the lungs and cause health problems, sometimes before a patient even knows they have RA. Like those that form on the joints, nodules that form in the lungs might be harmless. But unlike those in the joints, nodules in the lung may rupture and risk a collapsed lung.

What Are the Treatment Options?

In many cases, rheumatoid nodules do not require treatment. As long as the nodules are not causing significant pain or discomfort, they can usually be left alone. Some nodules may disappear on their own, but others may grow larger and eventually require treatment.

Though they are not acutely dangerous, some people may be alarmed by the appearance of rheumatoid nodules and may wish to treat them for cosmetic reasons. Other nodules may require treatment because they have caused the skin to be ulcerated or infected. There are several options for treating rheumatoid nodules:

  • Medications. Though medications are not a guaranteed way to remove rheumatoid nodules, certain disease-modifying antirheumatic drugs (DMARDs) may reduce the appearance of rheumatoid nodules, and since these are also medications used for the treatment of RA in general, they serve a double purpose.
  • Steroid injections. Steroid shots directly into the nodules can help shrink them.
  • Surgery. Particularly painful or infected nodules may require surgery for removal. Your doctor may also recommend surgery if you have tried other methods unsuccessfully.
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Nodules may grow back in the same spot after treatment, especially after surgery, so patients with especially severe rheumatoid nodules must receive more than one treatment.

It is important to note that while non-infected rheumatoid nodules do not generally require treatment, you should seek treatment immediately if your nodules become infected, or if you experience severe or worsening pain from your nodules.

Can They Be Prevented?

Unfortunately, rheumatoid nodules cannot always be prevented. However, there are some things you can do to reduce your chances of forming one or to prevent ones you have from growing worse.

Quit Smoking

Smoking increases the risk of rheumatoid nodules. Not only does smoking make it more difficult to do activities that relieve symptoms of RA, like exercise, smoking can also interfere with the action of certain arthritis medications. So, while quitting smoking is always a good idea in general, it is especially important for patients with RA.

Follow Medication Treatment Guidelines

Failing to take medications or otherwise disobeying the doctor’s guidance as far as treating your RA can increase the risk of developing rheumatoid nodules and in general make your life more difficult.

Increase Your Mobility

Being sedentary, especially if confined to a surface with many pressure points, can increase your chances of developing nodules. When possible, attempt to increase your mobility, possibly even exercising if you are able.

In Review

Rheumatoid nodules do not look great, and they can add an unsightly dimension to an already debilitating illness. However, they do not pose a great danger. Whether you need to have your nodules removed or not, there is nothing stopping you from continuing to live a vibrant, RA-managed life, even with a rheumatoid nodule or two.