Key takeaways

  • Rheumatoid nodules are firm lumps that commonly develop under the skin in individuals with rheumatoid arthritis, typically near affected joints like fingers and elbows.
  • While rheumatoid nodules are often painless, they can sometimes indicate underlying issues such as nerve impingement, infection, or ulceration.
  • Although there is no guaranteed prevention method, managing rheumatoid arthritis through medication, smoking cessation, and lifestyle adjustments can help minimize the likelihood of developing nodules.

Rheumatoid arthritis (RA) is a long-term progressive autoimmune condition that causes inflammation and pain in and around the joints.

Rheumatoid nodules can develop in the joints that RA affects. The nodules are usually not painful or tender, but in some cases they may be.

Keep reading to learn about where rheumatoid nodules form, what they look like, how to manage them, and more.

Rheumatoid nodules usually develop over joints that are subject to repeated trauma or pressure. Most commonly, they affect the:

  • fingers
  • elbows
  • backs of the heels

However, any part of the body that RA affects can develop rheumatoid nodules.

Rarely, nodules may develop in parts of the body that are not joints, including the:

  • eyes
  • lungs
  • vocal cords

Rheumatoid nodules typically do not cause pain. A painful nodule may be a sign of:

  • an impinged nerve
  • an infection
  • ulceration

Rheumatoid nodules commonly occur with RA. Around 20% of people with RA will develop rheumatoid nodules.

Rheumatoid nodules are also a sign of inflammation and heightened immune system activity.

Doctors still do not fully understand why rheumatoid nodules develop, so they cannot predict who will develop them and who will not. However, there are some potential risk factors.

There is a link between rheumatoid nodules and rheumatoid factor (RF), a protein that many people with RA have in their blood. Anti-citrullinated protein antibodies (ACPAs), which are antibodies to a person’s own proteins, may also play a role.

The following may also be risk factors for the development of rheumatoid nodules:

  • Taking methotrexate or other arthritis drugs: Some people taking methotrexate develop a condition called methotrexate-induced accelerated nodulosis. It causes nodules to develop, typically on the hands.
  • Physical injury or pressure: Repeated physical injury to the same area could cause a rheumatoid nodule. Pressure due to prolonged bedrest could also cause the nodules to develop, most likely on the heel, Achilles tendon, back of the head, hip, or sacrum at the base of the spine.
  • Having severe RA: People with more serious symptoms are more likely to develop nodules. This may be because people whose condition is advanced can also have high levels of rheumatoid factor.
  • Smoking: Individuals who smoke may be more likely to develop rheumatoid nodules.
  • Genetics: Certain genes predispose a person to rheumatoid nodules.

View the slideshow below for photos of rheumatoid nodules.

Unless rheumatoid nodules cause pain or other symptoms, they do not usually need treatment.

Injecting rheumatoid nodules with corticosteroids, such as methylprednisolone, may improve the symptoms, but this treatment also has risks. An injection may increase the chance of a nodule becoming infected or ulcerated.

If nodules are painful or present a cosmetic concern, a doctor can surgically remove them. However, doctors will not often recommend this approach because nodules frequently return after surgery.

Surgical excision to remove the nodule may be suitable if the nodule:

  • affects range of motion
  • traps peripheral nerves
  • ulcerates
  • becomes infected

A person can discuss the risks and benefits of surgery with a doctor.

It is not always necessary to treat rheumatoid nodules, but a person should contact a doctor if they experience symptoms such as pain or swelling. These symptoms may indicate infection or ulceration.

A person can also contact a doctor if they wish to discuss removing rheumatoid nodules for cosmetic reasons. The doctor can provide information about the benefits and risks so that the individual can make an informed decision about their treatment plan.

There is no guaranteed way to prevent rheumatoid nodules from developing. However, proper management of RA can help.

People with RA can help minimize the likelihood of nodules developing by:

  • stopping smoking, if applicable
  • taking medications as prescribed
  • reporting any new or worsening symptoms to a doctor as soon as possible
  • making lifestyle changes to increase mobility

Rheumatoid nodules may resolve on their own in some cases, but in others, they will persist. If they are in a sensitive spot, a person may require treatment.

Rheumatoid nodules are often benign and do not require treatment. However, if the nodule is painful, infected, or in an inconvenient location, a doctor can surgically remove it. However, it is common for nodules to recur after removal.

 

RA can sometimes cause complications in the lungs. Rarely, a person might develop pulmonary rheumatoid nodules, which are nodules on the lungs. Most of these nodules are noncancerous, but people with risk factors for cancer may need to undergo further evaluation.

Rheumatoid nodules can develop in people with rheumatoid arthritis (RA). They typically appear under the skin near joints, but they may develop internally in rare cases.

Risk factors for developing rheumatoid nodules include taking methotrexate or other arthritis drugs, smoking, sustaining an injury, and having severe RA. Certain genes may also predispose a person to rheumatoid nodules.

The nodules do not typically require treatment, but doctors may recommend corticosteroid injections or surgical removal if they are painful, infected, or ulcerated.