Nodules in Rheumatoid Arthritis

  • Beth S. RubenEmail author
  • M. Kari Connolly


Rheumatoid nodules (RN) are common in rheumatoid arthritis (RA) patients. Approximately one-quarter of RA patients will have them. They are one of seven diagnostic criteria for RA. They typically appear over bony prominences and joints such as the elbows and Achilles tendon. They are firm, subcutaneous, flesh-colored nodules that may grow to 1 cm in size or larger. They are usually non-tender. They are most often diagnosed clinically on exam and a biopsy is not necessary. They may occur in unusual locations such as the lungs and CNS. The differential diagnosis for RN includes acute rheumatic fever nodules, calcinosis, tophi, xanthomas, subcutaneous granuloma annulare, Gottron’s papules of dermatomyositis, and multicentric reticulohistiocytosis. Some SLE patients will develop RN. Less commonly, smaller, more papular lesions in a similar distribution in SLE and RA patient may have palisaded neutrophilic and granulomatous dermatitis (PNGD). Treatment of RN is the same as treatment of RA, but sometimes the RN may fail to respond. When confronted with an atypical nodule, a biopsy may be helpful. A biopsy of rheumatoid nodules demonstrates a palisaded granulomatous pattern with fibrosis and fibrin in the centers of palisaded zones. Some nodules in patients with rheumatoid arthritis and other autoimmune disease may display features of palisaded neutrophilic and granulomatous dermatitis.


Rheumatoid Arthritis Systemic Lupus Erythematosus Rheumatoid Arthritis Patient Systemic Lupus Erythematosus Patient Acute Rheumatic Fever 
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  1. 1.
    Harris ED, Firestein GS. Clinical features of rheumatoid arthritis. In: Firestein GS et al., editors. Kelley’s textbook of rheumatology. 8th ed. Philadelphia: Saunders Elsevier; 2009. p. 1087–118.CrossRefGoogle Scholar
  2. 2.
    Tehlirian CV, Bathon JM. Rheumatoid arthritis A. clinical and laboratory manifestations. In: Klippel JH et al., editors. Primer on the rheumatic diseases. 13th ed. New York: Springer Science; 2008. p. 114–21.Google Scholar
  3. 3.
    Chu P, Connolly MK, LeBoit PE. The histopathologic spectrum of palisaded neutrophilic and granulomatous dermatitis in patients with collagen vascular disease. Arch Dermatol. 1994;130(10):1278–83.PubMedCrossRefGoogle Scholar
  4. 4.
    García-Patos V. Rheumatoid nodule. Semin Cutan Med Surg. 2007;26(2):100–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Rencic A, Nousari CH. Other rheumatologic diseases. In: Bolognia JL et al., editors. Dermatology. 2nd ed. Philadelphia: Mosby Elsevier; 2008. p. 597–610.Google Scholar
  6. 6.
    Sangueza OP, Caudell MD, Mengesha YM, Davis LS, Barnes CJ, Griffin JE, Fleischer AB, Jorizzo JL. Palisaded neutrophilic granulomatous dermatitis in rheumatoid arthritis. J Am Acad Dermatol. 2002;47(2):251–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Collaris EJ, van Marion AM, Frank J, Poblete-Gutiérrez P. Cutaneous granulomas in rheumatoid arthritis. Int J Dermatol. 2007;46 Suppl 3:33–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Weedon D. Weedon’s skin pathology. 3rd ed. London: Churchill Livingstone; 2009. p. 183–4.Google Scholar

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© Springer Science+Business Media, LLC 2014

Authors and Affiliations

  1. 1.Departments of Dermatology and Pathology, Dermatopathology ServiceUniversity of CaliforniaSan FranciscoUSA
  2. 2.Departments of Dermatology and Internal MedicineUniversity of CaliforniaSan FranciscoUSA

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