Bumps under the skin? They could be a common symptom, more common among smokers: rheumatoid nodules.
Rheumatoid nodules appear as firm lumps underneath the skin. They arise near the joints affected by rheumatoid arthritis.
The nodules can vary in size, being anywhere from as small as a pea to as large as a walnut. It is possible for nodules to move under the skin. However, some will be connected to tendons or other soft tissue. These will remain in place.
In general, these types of nodules are relatively common. The National Rheumatoid Arthritis Society (NRAS) reports that up to 20% of people with rheumatoid arthritis will experience the symptom.
Where do rheumatoid nodules appear?
In most cases, a rheumatoid nodule appears in the hands, fingers or knuckles. Some people have them on their elbows.
It’s possible for a person to have rheumatoid nodules on their vocal cords, leading to hoarseness. Some people develop them in their organs such as the heart or lungs. Those who have rheumatoid arthritis in these areas of the body may notice a change in how the affected organs work.
If you notice changes or experience increased difficulty performing activities of daily living, be sure to bring it up with your RA Treatment Team.
Symptoms of rheumatoid nodules
For most people with RA, rheumatoid nodules do not add issues. However, it is possible to experience some symptoms beyond the physical bumps including:
- pain
- decreased joint mobility
- infection
- ulceration
- neuropathy
Causes of rheumatoid nodules
Generally, nodules appear in people who have severe cases of rheumatoid arthritis. In almost all cases, the patients who develop rheumatoid nodules have an autoantibody in the blood known as a “rheumatoid factor.” High rates of rheumatoid factor are common in people with RA and other autoimmune diseases like Sjögren syndrome.
Other common factors in the pathogenesis of the nodules, according to the Johns Hopkins Arthritis Center, include:
- trauma to small blood vessels near the pooling of immune complexes
- genetic predisposition
- pro-inflammatory cytokines
- activation of macrophage by immune complexes
Additionally, smoking may be a major factor in the development of the nodules. A study found that smoking cigarettes increased both the number and size of nodules in people with RA.
All participants in the study had RA. Of the participants, 70 were current smokers, 71 were former smokers, and 69 individuals never smoked. The current and former smokers experienced nodules more frequently than those who didn’t smoke.
Finally, a common RA medication may be a risk factor. Methotrexate is a medication commonly prescribed to patients with RA. About 8% of people on methotrexate develop micro-nodules.
A review published looked into this issue in 2002 – exploring a number of case studies that reported the link. However, based on the existing information and the nature of the previous reports, no definitive conclusions could be drawn.
Be sure to track your symptoms and to bring up any changes with your RA Treatment Team!
Treatment for rheumatoid nodules
Disease-modifying antirheumatic drugs, also referred to as DMARDs, may be taken to help alleviate the nodules. But, as mentioned above, medications like methotrexate present additional challenges and risks.
If the nodules become quite large in size, you may be prescribed a steroid injection to reduce the size.
Usually, surgery is not necessary to remove a rheumatoid nodule. It’s possible for the lumps to become infected or to interfere with daily life. In these cases, surgery may be necessary. But, it’s common for nodules to reoccur in a few months, even following surgery.