Rheumatoid nodules: causes, symptoms, diagnosis, treatment

In 20% of patients with rheumatoid arthritis, knotty rashes are revealed - rheumatoid nodules. Rheumatoid nodules are subcutaneous or periosteal nodules ranging in diameter from a few millimeters to 2 cm. More often the rashes are plural, they are painless. Located near the bone structures, often adjacent to the joints, especially the elbows, can be welded to the underlying tissues, with trauma - ulcerate. These nodules are clinically indistinguishable from rheumatic nodules, but are not accompanied by rheumatic disease, usually found in children, rarely in adults. They are considered specific for rheumatoid arthritis and are considered as one of the diagnostic criteria. Similar nodules were described in systemic lupus erythematosus, they are similar to the deep form of the annular granuloma; WF Lever et al. (1975) suggest calling them pseudo-rheumatoid nodules. The nodes most often appear in severe disease, when the serum often has positive anti-cervical and rheumatoid factors. Sometimes rashes occur in patients with an average severity of the process.

[1], [2], [3], [4], [5], [6], [7]

Histopathology

The nodes consist of fibrous tissue, in which there are foci of fibrinous necrosis, around which there are many fibroblasts and histiocytes. In addition, the presence of a young granulation tissue, amorphous material, remains of nuclei and the phenomenon of vasculitis in the nodes.

Pathomorphology

In the focus of the lesion, there are several clearly delineated areas of collagen fibrinoid necrosis. Surrounded by palisadically located histiocytes, among which there are lymphocytes, neutrophils, mast cells and giant multinuclear cells such as foreign bodies. There may be structures resembling sarcoid granulomas. In the stroma of the nodule - an inflammatory infiltrate consisting of lymphoid elements, proliferation of blood vessels and fibrosis.

Histogenesis is not sufficiently obese. It is believed that nodules arise as a result of the deposition of immune complexes in the vessels. With the direct reaction of immunofluorescence in the walls of the vessels, IgG and IgM deposits are detected.

Symptoms of rheumatoid nodules

The nodes are often located in the region of the radius, rarely in the knees, in the auricle, in the back of the hands, in the lower back, and possibly in other areas undergoing pressure. In these areas nodes appear several centimeters in diameter, single or multiple, of purple. Under the influence of injury nodes quickly ulcerate. The admission of staphylococcal infection can lead to staphylococcal sepsis and septic arthritis, sometimes rheumatic nodes can be located on the sclera (scleromalacia), while the sclera can atrophy and ulcerate, and blindness occurs.

Differential diagnosis

The disease should be distinguished from an annular granuloma, nodes with erythema nodosum, leprosy, sarcoidosis, etc.

[8], [9], [10], [11], [12], [13], [14], [15]

Treatment of rheumatoid nodules

The main disease is treated. Locally use corticosteroid ointments, creams. When ulcers use epithelializing agents.