Clinicopathologic features of rheumatoid nodules: a retrospective analysis
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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.
• 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.
KeywordsRheumatoid nodule Rheumatoid nodules Rheumatoid noduloses Rheumatoid nodulosis
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.
- 6.Knoess M, Krukemeyer MG, Kriegsmann J, Thabe H, Otto M, Krenn V (2008) Colocalization of C4d deposits/CD68+ macrophages in rheumatoid nodule and granuloma annulare: immunohistochemical evidence of a complement-mediated mechanism in fibrinoid necrosis. Pathol Res Pract 204(6):373–378. https://doi.org/10.1016/j.prp.2008.01.009 CrossRefGoogle Scholar
- 7.Nyhall-Wahlin BM, Turesson C, Jacobsson LT, Nilsson JA, Forslind K, Albertsson K, Ronnelid J, Petersson IF (2011) The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years. Scand J Rheumatol 40(2):81–87. https://doi.org/10.3109/03009742.2010.509103 CrossRefGoogle Scholar
- 11.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588. https://doi.org/10.1136/ard.2010.138461 CrossRefGoogle Scholar
- 12.Traistaru MR, Kamal D, Trasca DM, Foarfa MC, Gruia CL, Rogoveanu OC (2016) Rheumatoid nodules and quality of life in rheumatoid arthritis females - complex assessment. Romanian J Morphol Embryol 57(1):215–225Google Scholar
- 14.Houlder EL, Millier MJ, Highton J, Gwynne-Jones D, Stamp LK, Hessian PA (2017) Expression of the genes facilitating methotrexate action within subcutaneous rheumatoid nodules. Clin Exp Rheumatol 35(6):943–947Google Scholar
- 15.Soukup T, Dosedel M, Nekvindova J, Antonin Kubena A, Tacheci I, Duintjer Tebbens J, Vlcek J, Bradna P, Barvik I, Pavek P (2017) The plausible association of MTHFR and ADORA2A polymorphisms with nodules in rheumatoid arthritis patients treated with methotrexate. Pharmacogenet Genomics 27(2):43–50. https://doi.org/10.1097/FPC.0000000000000256 CrossRefGoogle Scholar
- 16.Wikaningrum R, Highton J, Parker A, Coleman M, Hessian PA, Roberts-Thompson PJ, Ahern MJ, Smith MD (1998) Pathogenic mechanisms in the rheumatoid nodule: comparison of proinflammatory cytokine production and cell adhesion molecule expression in rheumatoid nodules and synovial membranes from the same patient. Arthritis Rheum 41(10):1783–1797. https://doi.org/10.1002/1529-0131(199810)41:10<1783::AID-ART10>3.0.CO;2-W CrossRefGoogle Scholar
- 21.Urman A, Taklalsingh N, Sorrento C, McFarlane IM (2018) Inflammation beyond the joints: rheumatoid arthritis and cardiovascular disease. Scifed J Cardiol 2(3)Google Scholar
- 22.Turesson C, McClelland RL, Christianson TJ, Matteson EL (2007) Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis 66(1):70–75. https://doi.org/10.1136/ard.2006.052506 CrossRefGoogle Scholar