Rheumatoid Nodules: What Are They?

What do they look like?

Rheumatoid arthritis nodules can range in size from very small (around 2 millimeters) to larger (around 5 centimeters). They’re usually round in shape, though it’s possible they may have irregular borders.

The nodules typically feel firm to the touch and will usually move when pressed. Sometimes the nodules can form a connection with tissues or tendons underneath the skin and may not move when pressed.

The nodules may be tender to the touch. This usually occurs when a person is experiencing a rheumatoid arthritis flare-up.

Very large nodules or nodules on certain areas can press on nerves or blood vessels. This can cause discomfort and affect a person’s ability to move their hands, feet, and more.

Nodules vary in size, shape, and location on the body. Sometimes a person may have one nodule. Other times they may have a collection of smaller nodules.

Why do they form?

Doctors don’t know exactly why rheumatoid nodules form as a result of rheumatoid arthritis. Typically, a person gets rheumatoid nodules when they’ve had RA for several years. The nodules are made up of the following components:

• Fibrin. This is a protein that plays a role in blood clotting and can result from tissue damage.
• Inflammatory cells. Rheumatoid arthritis can cause inflammation in the body that leads to the development of nodules.
• Dead skin cells. Dead skin cells from proteins in the body can build up in the nodules.

The nodules can closely resemble some other conditions, such as epidermoid cysts, olecranon bursitis, and tophi caused by gout.

Where do they form?

Rheumatoid arthritis nodules can form in the following areas of the body:

• back of the heels
• elbows
• fingers
• knuckles
• lungs

These areas are usually where pressure is placed on the body’s surfaces or around highly used joints, like the elbows and fingers. If a person is confined to bed, they can develop rheumatoid arthritis nodules on:

• the back of their head
• heels
• sacrum
• other areas of pressure

In rare cases, the nodules can form in other areas, such as the eyes, lungs, or vocal cords. These may be difficult for a doctor to identify. However, these internal nodules can cause serious side effects, such as difficulty breathing, if the nodule is too large in size.

Are they painful?

Rheumatoid arthritis nodules aren’t always painful, though they can be. Sometimes the inflammation due to the nodules can cause a condition called vasculitis. This is an inflammation of the blood vessels that result in pain at the nodules.

Who typically gets them?

Several factors may put you more at risk for developing nodules. These include:

• Sex. Women are significantly more likely to get rheumatoid arthritis than men.
• Time. The longer someone has rheumatoid arthritis, the more likely they will develop nodules.
• Severity. Usually, the more severe a person’s rheumatoid arthritis, the more likely it is they will have nodules.
• Rheumatoid factor. People with higher levels of rheumatoid factor in their blood are also more likely to get nodules. Rheumatoid factor refers to proteins in the blood that are associated with autoimmune disorders, such as rheumatoid arthritis and Sjögren’s syndrome.
• Smoking. In addition to severe rheumatoid arthritis, smoking is another risk factor for rheumatoid nodules.
• Genetics. People with certain genes have a higher risk for developing rheumatoid arthritis.

How do you treat them?

Rheumatoid arthritis nodules don’t always require treatment. However, if they cause pain or restrict movement, your doctor may recommend treatments.

Taking medications known as disease-modifying antirheumatic drugs (DMARDs) may help to reduce the size of some rheumatoid nodules.

Doctors have linked another rheumatoid arthritis medication, methotrexate, with increasing the likelihood that nodules will get bigger. This medication suppresses the immune system. If the nodules are problematic, your doctor may recommend switching from methotrexate to another drug, if necessary.

Sometimes injections of corticosteroids can reduce inflammation and treat the rheumatoid nodules. If this doesn’t work, your doctor may recommend surgically removing the nodule or nodules. However, the nodules often return after surgical removal.

When to see a doctor

Rheumatoid nodules don’t always cause complications. However, it’s possible that on areas of greater pressure, such as the feet, the skin over the nodules can become irritated or infected. The results can be redness, swelling, and warmth at the nodules.

Infected nodules require medical attention. Antibiotics may be required to treat a nodule infection.

See your doctor if you have severe or worsening pain in any nodules you might have or the nodules are severely affecting your ability to move.

Nodules on the bottom of the feet may also make it difficult to walk, cause gait abnormalities, or shift stress to other joints, leading to knee, hip, or low back pain.

The bottom line

Rheumatoid arthritis nodules can range from annoying to painful. While they don’t usually require treatment, talk to your doctor if your symptoms start to become painful or you’re having difficulty with mobility.