Rheumatoid nodules

What are rheumatoid nodules? Where are they found?

Rheumatoid nodules are subcutaneous nodules that have the characteristic histology of a central area of fibrinoid necrosis surrounded by a zone of palisades of elongated histiocytes and a peripheral layer of cellular connective tissue. They occur in 20% to 35% of RA patients who typically are RF-positive and have severe disease. They tend to occur on the extensor surface of the forearms, in the olecranon bursa, over joints, and over pressure points such as sacrum, occiput, and heel. They frequently develop and enlarge when the patient’s RA is active and may resolve when disease activity is controlled. Methotrexate can rarely be associated with increased nodulosis in some RA patients, even when the disease is well controlled. Nodules caused by methotrexate tend to present as multiple small nodules on the finger pads.

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