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.
Key points
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Rheumatoid nodules are the common extra-articular manifestation of rheumatoid arthritis (RA).
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Systemic RA medications are not proven therapy for rheumatoid nodules; paradoxically, methotrexate and possibly other systemic therapies can induce or exacerbate nodule formation.
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Regardless of location, rheumatoid nodules have a consistent histologic appearance with a central area of fibrinoid necrosis, surrounded by palisading macrophages that are CD68 + and enclosed by a granulation layer.
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Subcutaneous nodules with typical clinical characteristics require neither biopsy for diagnosis nor specific treatment unless they are causing pain, interference in mechanical function, nerve compression, or other local phenomena.
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Pulmonary rheumatoid nodules require a more aggressive diagnostic evaluation to exclude malignancy, infection, or other causes of lung nodules.
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