Clinicopathologic features of rheumatoid nodules: a retrospective analysis

  • Seongsik Bang
  • Yeseul Kim
  • Kiseok Jang
  • Seung Sam Paik
  • Su-Jin ShinEmail author
Original Article



The clinical and histopathologic features of patients that have been diagnosed with rheumatoid nodules were investigated.


This study included patients with rheumatoid nodules, confirmed by histologic assessment, between 2005 and 2018 at the Hanyang University Hospital. Each patient had a total score of 6 or more according to the American College of Rheumatology criteria.


A total of 57 cases were included in this study. The median age of the patients at the time of diagnosis was 57 years (range, 39–70 years). The average duration between the onset of treatment and occurrence of rheumatoid nodule was 11.6 years. Bone erosion was observed in 44 patients (77.2%). Among 57 patients, 56 (98.2%) were treated with disease-modifying anti-rheumatic drugs; most of the patients (87.7%) showed high-positive rheumatoid factor or high-positive anti-citrullinated protein antibodies. The foot, hand, and wrist, in order of decreasing frequencies, were the anatomical sites with the highest occurrence of rheumatoid nodules, whereas, the soft tissue adjacent to the joint, subcutis, dermis, lung parenchyma, and submucosal layer of the supraglottic area, also in an order of highest frequency, were the histological sites with the highest occurrence. Microscopically, central necrobiosis was present in all cases. Stromal fibrosis (96.5%), palisading of histiocytes (82.5%), perivascular lymphocytic infiltration (68.4%), and cleft or cystic degeneration (63.2%) were also observed.


A clinicopathological review of cases diagnosed with rheumatoid nodules histologically was performed to confirm characteristics that can help clinicians understand the pathophysiology of the condition and make accurate diagnoses of rheumatoid nodules.

Key Points

• We reviewed the clinical, imaging, and histologic features of rheumatoid nodule.

• The average duration between the onset of treatment and occurrence of rheumatoid nodule was 11.6 years.

• Among 57 rheumatoid nodule patients, 98.2% were treated with disease-modifying anti-rheumatic drugs.


Rheumatoid nodule Rheumatoid nodules Rheumatoid noduloses Rheumatoid nodulosis 


Author contributions

Seong Sik Bang: assessment of the special staining slides; review of histological material; data analysis; drafting of the manuscript; preparation of the illustrations; preparation of the final text

Yeseul Kim: assessment of the immunohistochemical slides; review of histological material; preparation of the final text

Kiseok Jang: provided clinical data; preparation of the final text

Seung Sam Paik: provided clinical data; preparation of the final text

Su-Jin Shin: elaboration of the research concept; review of histological material; choice of cases for the study; general supervision of the study; drafting of the manuscript and preparation of the final text


This work was financially supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2017R1C1B5017930).

Compliance with ethical standards

The Institutional Review Board of the Hanyang University Hospital (HYUH 2018-10-006) approved the study and waived the requirement for informed consent.



Supplementary material

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Departments of Pathology, College of MedicineHanyang UniversitySeoulRepublic of Korea

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