- Discussion:
-
RA may cause symptoms because of pressure and location;
- nodules may be cosmetically unacceptable;
- nodulosis occurs in 20-25% of patients with R.A.
- associated with strong seropositivity;
- implies aggressive disease with poor prognosis;
- may occur in benign form of RA manifested by nodulosis & mild polyarthralgias;
- Histology:
- contain central area of necrotic fibrous & palisades of epithelioid cells inside
of an outer zone of chronic inflammatory cells;
- Treatment:
- not a priority unless erosion, pain, or infection present;
- cosmesis is factor if disfigurment of hand and forearms is major
concern to patient;
- nodules may recurr after resection;
- steroid injection can cause to regress, may cause ulceration of nodule
- careful dissection of nodule from skin meticulous hemostasis necessary
- protect nerves when applicable;
The subcutaneous rheumatoid nodule.
MH McGrath and A fleischer.
Hand Clinics. Vol 5. 1989. p 127-135.
