Rheumatoid nodules are firm lumps that develop under the skin. They are fairly unique to rheumatoid arthritis (RA) and usually occur near the affected joints.
About one-quarter of people with RA develop rheumatoid nodules. They are not contagious or dangerous, and they do not change color or bleed. Although pain is possible in some cases, the lumps are usually not tender.
People who have advanced RA or find it difficult to control the disease may have an increased risk of developing rheumatoid nodules. Some nodules may disappear over time, but others will grow larger. In terms of size, they can be as small as a pea or as large as a lemon. It is impossible to predict how individual rheumatoid nodules will change.
Keep reading to learn about where rheumatoid nodules form, what they look like, and how to manage them.
Rheumatoid nodules usually develop over joints that are subject to repeated trauma or pressure. Most commonly, they affect the:
- feet, especially the backs of the heels
However, any part of the body that RA affects can develop rheumatoid nodules. Rarely, nodules may develop in parts of the body that are not joints, including the:
- vocal cords
Rheumatoid nodules typically do not cause pain. A painful nodule may be a sign of an impinged nerve, an infection, inflammation, or ulceration.
RA is the primary cause of rheumatoid nodules, but some people with the disease are more susceptible than others to nodules. Rheumatoid nodules are also a sign of inflammation and heightened immune system activity.
Doctors still do not fully understand why rheumatoid nodules develop, so they cannot predict who will develop them and who will not. However, there are some potential risk factors.
There is a link between rheumatoid nodules and rheumatoid factor (RF), a protein that many people with RA have in their blood. Older research suggests that about
The following may also be risk factors for the development of rheumatoid nodules:
- Taking methotrexate or other arthritis drugs: Some people taking methotrexate develop a condition called
methotrexate-induced accelerated nodulosis. It causes nodules on the feet, hands, and ears.
- Trauma near a pressure point: People are more likely to develop rheumatoid nodules on pressure points. Experiencing a cut or bruise in these areas increases the likelihood of developing a rheumatoid nodule.
- Having severe RA: People with more serious symptoms are more likely to develop nodules. This may be because people whose condition is advanced can also have high levels of rheumatoid factor.
- Smoking: Individuals who smoke may be more likely to develop rheumatoid nodules.
- Genetics: Certain genes predispose a person to rheumatoid nodules.
The following are examples of rheumatoid nodules:
Unless rheumatoid nodules cause pain or other symptoms, they do not usually need treatment. The goal of treatment should be to manage the symptoms of the underlying disease.
Numerous treatments are available to manage RA symptoms, including:
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs slow the progression of RA, with a type called biologics being especially effective. Some research suggests that treatment with the biologic rituximab may reduce the likelihood of nodules developing.
- Physical therapy: Treatment approaches such as joint mobilizations, manual therapy, strength training, and mobility training can help retain mobility and reduce pain.
- Pain relievers: Doctors may recommend taking nonsteroidal anti-inflammatory drugs or using them topically.
- Steroid medications: Steroids, such as prednisone, can reduce the inflammation that causes pain and other symptoms.
If nodules are painful or present a cosmetic concern, a doctor can surgically remove them. However, doctors will not often recommend this approach because nodules frequently return after surgery.
Injecting rheumatoid nodules with corticosteroids, such as methylprednisolone, may improve the symptoms, but this treatment also has risks. An injection may increase the chance of a nodule becoming infected or ulcerated.
A person can discuss the risks and benefits with a doctor.
It is not always necessary to treat rheumatoid nodules, but a person should contact a doctor if they experience symptoms such as pain or swelling. These symptoms may indicate infection or ulceration.
Having rheumatoid nodules and managing RA symptoms can be frustrating, and it may sometimes cause feelings of psychological stress, anxiety, or depression. Anyone who experiences these feelings should discuss them with a healthcare professional. A healthcare professional can recommend appropriate treatments for behavioral health as well as physical health.
There is no guaranteed way to prevent rheumatoid nodules from developing. However, proper management of RA can help. People with RA can help minimize the likelihood of nodules developing by:
- stopping smoking, if applicable
- taking medications as prescribed
- reporting any new or worsening symptoms to a doctor as soon as possible
- making lifestyle changes to increase mobility
Below, we answer some commonly asked questions about rheumatoid nodules.
Can rheumatoid nodules go away?
The nodules may resolve on their own in some cases, but in others, they will persist. If they are in a sensitive spot, a person may require treatment.
Is it possible to remove rheumatoid nodules?
Rheumatoid nodules are often benign and do not require treatment. However, if they are in certain locations — such as on a finger joint or a heel — they can cause problems.
If the nodule is painful, infected, or in an inconvenient location, a doctor can surgically remove it. However, it is common for nodules to recur after removal.
What does it mean to have nodules on the lung?
RA can sometimes cause complications in the lungs. Rarely, a person
Rheumatoid nodules are not an uncommon complication of RA. They typically appear under the skin near joints, but they may develop internally in rare cases.
Risk factors for developing rheumatoid nodules include taking methotrexate or other arthritis drugs, smoking, sustaining an injury near a pressure point, and having severe RA. Certain genes may also predispose a person to rheumatoid nodules.
The nodules do not typically require treatment, but doctors may recommend corticosteroid injections or surgical removal if they are painful, infected, or ulcerated.