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Rheumatoid Nodules

- Discussion:
    - RA may cause symptoms because of pressure and location;
    - nodules may be cosmetically unacceptable;
    - nodulosis occurs in 20-25% of patients with RA
    - 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.