SYMPTOMS OF RHEUMATOID ARTHRITIS (RA): SKIN
People generally first notice skin nodules while dressing or bathing. They appear beneath the skin as small knots called rheumatoid nodules, and they occur in approximately one quarter of people with established RA. They are more likely to appear in people who have rheumatoid factor than in people who don’t have it.
Skin nodules often form close to joints, overlying areas that are susceptible to trauma or pressure such as tendons or bony protrusions like the elbows, knuckles, or Achilles tendon. They often come and go in a pattern that follows the pattern of arthritis.
Rheumatoid nodules are benign (harmless) lumps that should not be confused with enlarged lymph nodes or tumors (which may or may not be harmless). The nodules are only bothersome when they press against internal body structures, interfere with the motion of a joint or tendon, or become infected. Rheumatoid nodules are not painful unless they are positioned in an area that is frequently traumatized, such as the heel tendon, which is rubbed by the back of the shoe. Rheumatoid nodules rarely appear in places other than the skin. On occasion they do appear in the lungs, heart, eyes, and vocal cords, but even in these places rheumatoid nodules seldom produce symptoms.
Rheumatoid nodules themselves do not merit special treatment unless they cause pain, decrease function, or become infected. Anyone who has rheumatoid nodules, however, should be considered for treatment with drugs that can produce remission since the presence of nodules may indicate a more serious form of arthritis. Successful treatment with DMARDs can result in the resolution of nodules as well as improvement in arthritis. In a specific situation in which a particular nodule is causing structural problems, surgical removal is an option. Although removal of nodules for cosmetic reasons is generally discouraged, surgery is occasionally performed to improve appearance, too.
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