9 Things to Know About Rheumatoid Arthritis Nodules
Rheumatoid arthritis (RA) is an autoimmune disorder that affects the lining of your joints, causing painful inflammation and swelling, according to the Arthritis Foundation. In some people, the condition can also damage other parts of the body, too, including the lungs and the eyes. While a wide range of symptoms can result from RA, nodules are a very visible, though usually harmless, sign of the disease. Keep reading to learn more about what exactly nodules are, how they develop in the first place, how they may affect your daily life, and of course, the best ways to treat them.
What Are RA Nodules?
“Rheumatoid nodules are hard lumps that can present under the skin in patients with RA,” explains Marven G. Cabling, M.D., a rheumatologist at Loma Linda University Health in Loma Linda, CA. “They are typically seen close to the joints in varying sizes, from a few millimeters to several centimeters.” (Think the size of a pea all the way up to a big walnut.) Sometimes these firm lumps of tissue are painless, he says, but others can be painful, depending on where they are in the body. More often than not, though, nodules are more of a cosmetic concern than physically disabling, Dr. Cabling says.
RA Nodules Are Fairly Common
Nodules are one of the most common symptoms of RA that appear outside of the joints themselves, according to Johns Hopkins Arthritis Center. Some studies show up to 40% of people with RA have nodules at some point, says Kevin Deane, M.D., a rheumatologist at UCHealth Rheumatology Clinic in Aurora, CO. “However, many think that with modern therapies in RA that nodules are becoming rarer,” he adds. In most cases, nodules show up after you’ve had the arthritis symptom of RA for several years.
High-Traffic Areas Are Often Inflammation’s Targets
Autoimmune diseases like RA occur when the immune system mistakenly attacks the body, per the Arthritis Foundation. And while joints are RA’s main target, sometimes those attacks can result in inflammation elsewhere, too, such as under the skin in the form of nodules, explains Dr. Deane. “In particular, it is thought that the nodules develop as a response to skin irritation, and that may be why they are mostly [but not always] found in areas of skin that get a lot of use, such as around the elbows, hands, and feet,” he adds.
RA Nodules Can Appear in Many Different Parts of the Body
While nodules usually develop in those highly used areas, those aren’t the only parts of the body where nodules may develop. “Other dependent parts, such as the Achilles and heel region, hips, sacrum, and the back of the scalp may be affected, especially in bedridden individuals,” says Dr. Cabling. More rarely, nodules can develop in places other than right under the skin, such as in the eyes, lungs, heart valves, or vocal cords, he says. Smoking is a risk factor for the development of lung nodules, adds Dr. Deane.
There Are Other Risk Factors for RA Nodules
Rheumatoid nodules may be more likely to show up in people with more severe and uncontrolled RA, Dr. Deane explains. “In addition, some people think they can be a very rare side effect [in some patients] of a medication called methotrexate that is commonly used to treat RA,” he says. “How often or why this may occur isn’t well-understood, and there is some controversy about whether it is really methotrexate causing the nodules or not.” If you are getting more nodules while taking this drug, your doctor may want to try a different medication, Dr. Deane says.
Some Nodules May Affect Your Activities
So, what makes some nodules painful rather than painless? Again, it has to do with where, exactly, the nodule has developed, says Dr. Cabling. “When resulting in pressure on an adjacent nerve, [they can be] quite painful, frequently limiting mobility and/or functioning,” he explains. “An example would be a nodule in the elbow where a patient is no longer able to straighten that elbow or rest it on a table or chair because of the pain from pressure on the nodule.” Sometimes nodules near the finger joint can cause joint deformities, which can also limit their use, he adds.
There Are Several Treatment Options
In most cases, nodules themselves don’t require a specific treatment, says Dr. Deane. “One of the best treatments for nodules is to get RA in general under very good control with typical immune-modifying drugs,” he explains. Certain drugs, like rituximab or others that inhibit the inflammatory protein IL-6, may work especially well, he says. For nodules that are treatment-resistant, infected, deforming, or debilitating, your doctor may suggest injecting steroids into it or surgically removing it, says Dr. Cabling. Your doctor also may refer you to an occupational therapist for help managing nodule-related issues, he says.
Sometimes Nodules Recur After Treatment
“If local injection and/or surgical removal of nodules is done along with good treatment for RA in general, often the nodules will go away forever,” says Dr. Deane. Unfortunately, there’s a chance that nodules that have gone away after treatment can come back. "Even after surgical excision, recurrence is common at the same site,” says Dr. Cabling. Recurrence likely happens for the same reasons they develop in the first place—high-traffic areas are subjected to repeated pressure or trauma, leading to inflammation and a new nodule forming, he says.
You Should Report Any New Lumps to Your Doctor
While many nodules are painless, that doesn’t mean you should ignore any new lumps or bumps you find on your body when you have RA. While it could be an RA nodule, other things like gout and calcium deposits may cause lumps on the body. “Most of the time, a rheumatologist can tell if it is an RA nodule by looking at it and touching it,” explains Dr. Deane. “However, sometimes they use a needle or perform a biopsy to make sure it isn’t something else.”
The Bottom Line on RA Nodules
While nodules may be annoying and not-so-pretty to look at, remember, it’s inflammation from RA that usually causes the pain, not the nodules that result from it. These bumps often don’t hurt, nor are they particularly bothersome beyond cosmetic reasons, Dr. Cabling says. That said, in some folks, they can become disabling and require more specific treatment. “It is with proper therapy of the underlying RA that the development of these nodules can be prevented,” Dr. Cabling reminds us. “I would recommend having a good follow-up and relationship with your rheumatologist.”
Rheumatoid Arthritis Information: The Arthritis Foundation. (2021.) “Rheumatoid Arthritis: Causes, Symptoms, Treatments and More.” arthritis.org/diseases/rheumatoid-arthritis
RA Nodules Symptoms: Johns Hopkins Arthritis Center. (2021.) “Rheumatoid Arthritis Signs and Symptoms.” hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/