What to Know About Rheumatoid Arthritis Nodules

By

Chris Iliades, MD

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Rheumatoid arthritis (RA) nodules are the most common sign of RA after joint symptoms. RA is an autoimmune disease, which means that your immune system—your body’s defense system—mistakenly attacks normal cells of your body, causing inflammation. With RA, most of the inflammation takes place in the lining inside your joints, called the synovium. However, RA inflammation can also cause firm lumps, or nodules, under your skin. Most of the time, nodules form after joint symptoms have already developed.

You may never get nodules. In fact, just 25% of people with RA do. If you're taking the RA drug methotrexate, your chances of getting nodules are higher. There's some evidence that newer medications for RA, called disease-modifying anti-rheumatic drugs (DMARDs), are decreasing the risk for nodules.

Signs and Symptoms of RA Nodules

You can have single or multiple nodules. They usually feel firm and painless, and you might be able to move them around under your skin. The skin over the nodules usually does not change color, but you may notice that it looks shiny. RA nodules usually form over pressure points and parts of your body that get wear and tear, so you're more likely to get them around your elbows, hands, and heels.

You may also notice these signs and symptoms:

  • RA nodules related to methotrexate tend to be smaller and appear mainly in fingers and elbows.

  • Most RA nodules range from pea size to the size of a golf ball or lemon.

  • RA nodules can be uncomfortable when they're large or located on areas that are sensitive, like the palms of your hand or soles of your feet.

  • RA nodules can be painful if they are pushing on a nerve, or if they become infected.

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