Rheumatoid Nodules

What are rheumatoid nodules?

Rheumatoid nodules are bumps that may form under your skin or inside your body when you have rheumatoid arthritis (RA).

A nodule is the medical term for a tumor that’s less than an inch (around 3 millimeters) across. Rheumatoid nodules are benign (noncancerous). Having them isn’t a sign of cancer and doesn’t mean you’ll develop cancer later. They’re made of clumped up cells that usually include:

• Dead skin cells
• Fibrin cells (a tough, dense protein)
• Inflammatory cells from your immune system

Where do rheumatoid nodules develop?

Rheumatoid nodules usually develop near parts of your body that you use a lot during your everyday routine. Some of the most common places include:

• Elbows
• Fingers
• Forearms
• Heels or near your Achilles tendon
• Hips
• Low back (your sacrum)
• Scalp (especially if you’re immobile or can’t move from bed)

It’s less common, but rheumatoid nodules can also form in other places of your body, including inside your:

• Lungs (pulmonary nodules)
• Sclera (the white part of your eye)
• Vocal cords (vocal cord lesions)

What do rheumatoid nodules feel like?

The nodules may feel firm (like a small pebble trapped under your skin), but they can also feel squishy (like a stress ball). They can range in size from smaller than a pencil eraser to as big as a computer mouse (nodules this big are rare).

Rheumatoid nodules don’t usually hurt, but the area around them can feel tender — especially if they’re near a joint where you’re experiencing RA symptoms.

You usually won’t be able to feel nodules in your lungs, eyes or vocal cords. You may not even know you have them until they show up as an incidental finding during an imaging test like an X-ray or part of your routine eye exam.

What causes rheumatoid nodules?

The same autoimmune response that causes rheumatoid arthritis also causes rheumatoid nodules. But not everyone with RA gets rheumatoid nodules. Experts estimate that between 25% and 40% of people with RA develop rheumatoid nodules. And less than 1% of people with RA get nodules in their lungs, eyes or vocal cords.

If you have RA, your immune system attacks tissue in your joints and causes inflammation. Over time, this inflammation damages your affected joints and causes symptoms like pain and stiffness. It’s an autoimmune disease — any health condition where your immune system hurts your body instead of protecting it.

If your immune system is overly active, it can irritate tissue throughout your body, especially around joints you use a lot. For example, if you have RA and use your hands a lot (like working with tools), you might have a higher risk of developing rheumatoid nodules around your fingers.

You’re more likely to have rheumatoid nodules if you have a high rheumatoid factor or cyclic citrullinated peptide (CCP) antibodies. A healthcare provider can check your levels with a blood test.

How do you get rid of rheumatoid nodules?

You may not need treatment for rheumatoid nodules. Sometimes, they go away on their own. In the same way that RA symptoms can come and go (flares or flare-ups), you might notice that rheumatoid nodules appear, then reabsorb back into your body without any treatment.

How long they last can vary depending on where they develop, which stage of RA you have and your overall health.

Your provider may give you treatments for rheumatoid nodules if they’re painful or don’t go away on their own. Your provider can also treat rheumatoid nodules if having them affects your self-confidence.

Common rheumatoid nodule treatments include:

• Corticosteroids. Corticosteroids are prescription anti-inflammatory medications that manage RA and can calm your immune system’s overactivity. Your provider may give you a cortisone shot near the nodules.
• Disease-modifying antirheumatic drugs (DMARDS). DMARDS are a type of immunosuppressant that can settle down your immune system and reduce how much inflammation it causes in your body.
• NSAIDs. Over-the-counter NSAIDs reduce inflammation throughout your body. Your provider will tell you which one(s) will work best for you.
• Monoclonal antibodies. Monoclonal antibodies are artificial antibodies that can help regulate your immune system. Your provider might suggest rituximab injections.

Should rheumatoid nodules be removed?

You probably won’t need surgery to remove rheumatoid nodules. Your provider might suggest surgery to remove them if they:

• Are in, on or near an organ inside your body and haven’t gone away on their own
• Are very large
• Haven’t gone away after you’ve tried other, nonsurgical treatments
• Make it hard to use your hands, arms or other body parts (especially if you accidentally hit or bump the nodules during your daily routine)

When should I see a healthcare provider if I have rheumatoid nodules?

Visit a healthcare provider if you notice any changes or new symptoms on or under your skin. If you have RA, you may already be managing it with treatments. Tell your provider if it feels like your treatments aren’t working as well as they used to.

Your provider will want to keep an eye on rheumatoid nodules, especially if you’ve never had them before. They’ll tell you when you’ll need follow-up appointments and when to contact them if anything changes.