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Rheumatoid Nodules

What are they?

Rheumatoid nodules are growths that develop over pressure points in patients with rheumatoid arthritis. They frequently develop along or within tendons in apparent response to pressure and friction. These nodular growths are soft tissue enlargements that can vary in size from a small grape or marble to that of a walnut or even larger. They are commonly located in the forefoot areas and often involve the same areas of both feet. Rheumatoid nodules are usually not painful to the patient but can cause other problems such as shoe wear difficulties, gait and balance abnormalities, and cosmetic disturbances.

What causes them?

The disease process of rheumatoid arthritis causes rheumatoid nodules. They are usually seen in patients with well-established rheumatoid arthritis. As stated earlier, they can enlarge over time and subsequently interfere with one's normal ambulation and shoe use. Weight bearing pressure seems to be a primary culprit as a cause for these growths since they frequently involve the forefoot areas. Additional research however, will be necessary to identify any confirmed causative factors.

How do you treat them?

The treatment for rheumatoid nodules is reserved primarily for those cases where the patient is complaining of pain, disability, or progressive growth of the lesion. Specific care involves off-loading of the nodule to decrease pain, possible steroid injections, physical therapy, and various oral medications. Special care and precautions should be taken when injecting steroids into or near tendons in order to prevent a weakening and/or rupture of the tendon structure. In certain cases, surgical removal of the nodules is used but with the understanding that there is a relatively high rate of reoccurrence reported in the literature.

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