Treatment of Rheumatoid Nodules in Rheumatoid Arthritis

Rheumatoid Nodules

Rheumatoid arthritis is one of the most common forms of arthritis and chronic condition. The joints of various bones are affected by the inflammatory process, resulting in pain, redness and a reduced range of motion. If the condition is not managed in time, the cartilage can be permanently destroyed.

As a complication of this type of arthritis, rheumatoid nodules can occur. These nodules can appear in various parts of the body, having different sizes and causing discomfort. In making the diagnosis, it is essential to determine whether these nodules are the result of rheumatoid arthritis or another condition. The diagnosis will also guide the physician towards the right treatment/management plan. (R)

Overview of rheumatoid nodules

These are inflammatory nodules and they can represent a sign that the condition has progressed to a severe level. The nodules form in the fat layer underneath the skin, over time and they are mobile, meaning they can be moved. Inflammation is present and the nodules are not sensitive to pressure or touch.

The tendency is for these nodules to form in contact pressure areas, such as the elbows, forearms or hands (generally on the extensor side of the joints). In rare cases, they can appear at the level of internal organs, abdominal wall, ears, eyes and Achilles tendon.

Their size can vary from small (pea size) to large (plum or tennis ball). If one already suffers from rheumatoid arthritis, the presence of nodules can be a sign of an advanced stage. However, these nodules can also raise the question about another diagnosis, such as a soft tissue tumor.

The treating physician should analyze all of the rheumatoid nodules, present in different parts of the body. The end joints should be analyzed in particular and it is also important to make a differential diagnosis. For example, these nodules can be confused with gout, which is caused by the excess accumulation of uric acid in various joints. Only a specialist can determine the exact cause for which the nodules have appeared. (R)

What are the symptoms associated with rheumatoid nodules?

When the nodules begin to form, they can cause little or no discomfort. The skin around the joints can become red, with pain and inflammation occurring as a result. In advanced stages, one might suffer from a reduced range of motion in the affected joints, as well as reduced sensitivity and strength. The fine motor skills might be affected as well.

In the case of significant swelling, one might be bothered not only by the actual appearance. These changes can cause severe discomfort, preventing one from engaging in daily living activities. Additional symptoms might be present, with profuse sweating, fever, tiredness and weight loss.

It is possible that both hands are affected by the presence of rheumatoid arthritis and the subsequent nodules. In the situation that the nodules are present for more than six weeks, it is certain that they are of rheumatic nature. The pain might be present particularly during the night and with physical rest. The longer the joints are not moved, the more intense the pain is going to be.

The symptoms might be present in one or several joints, and they will not necessarily remain constant. As mentioned above, the rheumatoid nodules can appear at the level of internal organs, such as lungs. In general, these do not cause any symptoms. The regular examination is essential, in order to ensure that these nodules are not actually caused by tuberculosis or cancer.

The joints that are affected by rheumatic changes can cause severe discomfort and, if no treatment measures are taken, the condition will continue to progress. The range of motion can be severely reduced, with the inflammatory processes causing the joints to become deformed and damaged. (R)

What is the cause of rheumatoid nodules?

The exact cause that leads to the appearance of rheumatoid nodules is not known. In those who suffer from rheumatoid arthritis, the immune system can attack the joints, leading to inflammation, pain and stiffness. This is known as an autoimmune reaction.

The rheumatoid nodules appear as a result of an inflammatory process, which is present in the synovial membrane. They affect the integrity of the joints, with the cartilage-growing excessively as compensation.

Some studies have revealed that tissue injuries, associated with blood vessel damage, can lead to the appearance of rheumatoid nodules. These can cause pro-inflammatory enzymes to accumulate in the joints, which in turn will cause the above-mentioned symptoms. The accumulation of necrotic tissue will complicate the condition.

Medication can favor the appearance of rheumatoid nodules in some cases. For example, people who take methotrexate – a drug prescribed for various form of cancer and other chronic inflammatory conditions – present a higher risk of developing such nodules.

In the majority of the cases, however, the nodules form in severe forms of rheumatoid arthritis (chronic condition). They are also more common in those who suffer from inflammatory conditions or infections, affecting the lungs, gastrointestinal system or even the blood vessels. According to the research made in the field, the nodules appear in response to the inflammatory and infectious processes within the body. (R)

Management or rheumatoid nodules

health diaryIn the situation that the rheumatoid nodules are not large or bothersome, no treatment is necessary. The treatment should be directed towards the underlying condition, such as rheumatoid arthritis. The main purpose is to prevent the deformity of the joints, improve the overall mobility and guarantee the necessary pain relief.

Oral medication is recommended for the relief of both pain and inflammation, improving the joint function in consequence. Cortisone injections are prescribed for more severe cases, but they cannot be used as a long term treatment (risk of adverse reactions).

Physiotherapy is one of the most advised forms of treatment for both rheumatoid nodules and the associated nodules. It can ensure the necessary joint flexibility and relief from pain, inflammation, and other symptoms. The physiotherapist will recommend a set of exercises and movements to be performed, which are meant to preserve the functionality of the affected joints.

Patients who are diagnosed with this condition are advised to change their diet as well. The recommendation is to avoid inflammatory foods, such as red meat, sugar, high fructose corn syrup, trans fats, refined carbs, and processed food products. A healthy diet should be based on fresh fruits and vegetables, fatty fish and lean meat. These foods fight inflammation, improving the manifestation of rheumatoid arthritis.

In the situation that the rheumatoid nodules are large and restrict the movement of the respective joints, the surgical intervention might be recommended. After removal and the subsequent post-operative period, physiotherapy should be resumed. This is meant to prevent the worsening of rheumatoid arthritis, as well as the subsequent formation of nodules (if possible).

If the affected joint is completely deformed, the doctor might recommend joint replacement surgery. Depending on the severity of the deformation, the procedure might involve partial or total joint replacement. (R)

CareClinic, a health app to manage your rheumatoid arthritis

CareClinic is a health app which can be used to manage every aspect related to your rheumatoid arthritis, including rheumatoid nodules. It is easy to use, allowing you to keep track of your symptoms and the progress of the condition in general. At the end of each month, you are given a report of your progress, which can be shared with the treating physician.

Within the application, you can record the entire treatment plan, including the medication and various therapies. If you are having difficulties with medication adherence, you can set up reminders for each of your treatments. You will also find the built-in journal to be a useful feature, allowing you to write about your emotions, thoughts and feelings with regard to life with rheumatoid arthritis.

Why is it helpful to keep track to your symptoms?

The answer is simple. You need to pay close attention to the way you are feeling, as this will help the doctor come up with the best treatment solutions. If you rely on your memory exclusively, you might have difficulties recalling the different symptoms you experienced.

The CareClinic app permits you to implement lifestyle changes and improve your overall quality of life. You can use it to track the intensity of the pain and inflammation, to keep track of joint function and determine if the current medication is helpful or not. Moreover, you can record additional health measurements (weight, blood pressure), as well as water intake, tracking sleep, physical activity and mood.

If you have been diagnosed with rheumatoid arthritis, you are probably affected by weather changes. You can use the application to keep track of humidity levels and outdoor temperature, identifying changes that trigger discomforting symptoms.

As pain is one of the most bothersome symptoms of rheumatoid arthritis, being often aggravated by the presence of these nodules, you might want to consider using the application to track your pain levels in accordance to various activities. For example, you might be in a lot of pain after sleeping the entire night.

The main benefit of this health app is that you can understand your condition, keeping track of every influencing factor. These factors include not only the diet and physical activity, but also the quality & frequency of sleep, habits, medication and mood.

With regard to treatment, you can organize a list – within the application – of every solution you have tried and how effective it was. From time to time, you can review these treatment solutions and discuss with your doctor about potential changes that could be made.

If you are looking to take things to the next level, you can use the application to make a thorough record of all joints that are swollen and tender. You can record the location of your rheumatoid nodules and the different pain triggers. On your next appointment, you will find it easier to discuss your condition, as the application will offer an accurate account of your progress.

Several facts on rheumatoid arthritis

Rheumatoid arthritis is the third most common type of arthritis, following osteoarthritis and gout. The chronic condition affects 1.3 million people only in the United States, and 1% of the entire population worldwide. It is also important to mention that women are three times more likely to develop rheumatoid arthritis than men.

The predominant age category for the appearance of rheumatoid arthritis is 30 – 60. However, women can experience the manifestations of this condition sooner than men. Genetics, environmental, hormonal and lifestyle factors are considered to be behind this inflammatory illness. In some cases, rheumatoid arthritis might shorten the overall life expectancy. This is often the result of complications, such as anemia, respiratory issues and rheumatoid nodules. (R)

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Alexandra V.
Alexandra V.
Alexandra V. holds a degree in Physiotherapy from the University of Medicine and Pharmacy Carol Davila. She holds an additional degree in Journalism and writes in English and German. She is passionate about preventative health care and an undergrad in Medicine.
Alexandra V.