Rheumatoid nodulosis
| Rheumatoid nodulosis | |
|---|---|
| Other names | Accelerated rheumatoid nodulosis[1] |
| Specialty | Dermatology |
Rheumatoid nodulosis is a cutaneous condition associated with rheumatoid arthritis, characterized by the appearance of multiple nodules, most often on the hands.[1]
Signs and symptoms
The classic description of rheumatoid nodulosis in adults is that it is a variation of rheumatoid arthritis (RA) that appears as a proliferation of subcutaneous nodules, frequently on the hands and feet, linked to palindromic rheumatism without loss of joint function and with minimal to no systemic symptoms.[2]
Mechanism
There are numerous theories regarding the pathophysiology of nodules linked to RA, and none of them are entirely accepted.[2] Some have hypothesised that minor local trauma to small blood vessels induces nodules by causing rheumatoid factor-containing immune complexes to pool.[3] It is believed that these immune complexes cause the release of chemotactic factors by activating nearby macrophages. More macrophages are drawn in by this process, which ultimately results in the formation of granulomas with central necrosis.[2] Some have proposed theories regarding the role of underlying vasculitis or genetic factors in the development of RA nodules.[4][5]
Treatment
Generally, there is no need for treatment for the lesions; however, on rare occasions, nonsteroidal anti-inflammatory medications or intralesional corticosteroids may be necessary. In patients with severe local discomfort who are highly symptomatic, resection may be an option.[6]
Epidemiology
About 20% of people with rheumatoid arthritis develop rheumatoid nodules, which are linked to more severe erosive disease in those patients.[2] The nodules are more common in men, typically manifest in the fifth decade of life, and are primarily found on extensor surfaces like the backs of the fingers and elbows, though they can occur anywhere.[7]
See also
References
- ^ a b Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
- ^ a b c d Evangelisto, Amy (2003). "Rheumatoid Nodulosis". JCR: Journal of Clinical Rheumatology. 9 (5). Ovid Technologies (Wolters Kluwer Health): 287–290. doi:10.1097/01.rhu.0000089982.58867.73. ISSN 1076-1608. PMID 17041477.
- ^ Ziff, Morris (1990). "The rheumatoid nodule". Arthritis & Rheumatism. 33 (6). Wiley: 761–767. doi:10.1002/art.1780330601. ISSN 0004-3591. PMID 2194460.
- ^ L, Sokoloff; RT, McCLUSKEY (1953). "The vascularity of the early subcutaneous nodules of rheumatoid arthritis". Bulletin of the New York Academy of Medicine. 29 (9). Bull N Y Acad Med: 733–734. ISSN 0028-7091. PMC 1877362. PMID 13082347.
- ^ Panayi, G S; Wooley, P; Batchelor, J R (November 11, 1978). "Genetic basis of rheumatoid disease: HLA antigens, disease manifestations, and toxic reactions to drugs". BMJ. 2 (6148): 1326–1328. doi:10.1136/bmj.2.6148.1326. ISSN 0959-8138. PMC 1608410. PMID 719380.
- ^ Álvarez-Chinchilla, P.J.; Poveda Montoyo, I.; Illán, F.; Bañuls Roca, J. (2019). "Rheumatoid Nodulosis in an Adult Patient Negative for Rheumatoid Factor". Actas Dermo-Sifiliográficas (English Edition). 110 (10). Elsevier BV: 865–867. doi:10.1016/j.adengl.2018.06.028. ISSN 1578-2190.
- ^ García-Patos, Vicente (2007). "Rheumatoid Nodule". Seminars in Cutaneous Medicine and Surgery. 26 (2). Frontline Medical Communications, Inc.: 100–107. doi:10.1016/j.sder.2007.02.007. ISSN 1085-5629. PMID 17544962.
Further reading
- Maldonado, Irama; Eid, Hala; Rodriguez, Graciela R.; Rillo, Oscar L.; Barcat, Jose A.; Reginato, Antonio J. (2003). "Rheumatoid Nodulosis". JCR: Journal of Clinical Rheumatology. 9 (5). Ovid Technologies (Wolters Kluwer Health): 296–305. doi:10.1097/01.rhu.0000090260.82835.64. ISSN 1076-1608. PMID 17041479. S2CID 28531921.
- Enginar, Ayşe Ünal (May 14, 2019). "Accelerated Nodulosis in a Patient With Rheumatoid Arthritis". Archives of Rheumatology. 34 (2). The Archives of Rheumatology: 225–228. doi:10.5606/archrheumatol.2019.7020. ISSN 2148-5046. PMC 6719578. PMID 31497770.