Rheumatoid nodule in Adult
Alerts and Notices
Synopsis
Patients affected with rheumatoid nodules will often have a high titer of rheumatoid factor. In addition, patients with RA who are positive for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) antibodies are more likely to develop rheumatoid nodules. However, patients with mild RA may also develop rheumatoid nodules, as may patients who have rheumatoid disease without significant joint involvement. Nodules can also precede the onset of clinically significant arthritis by a number of years.
Rheumatoid nodules may persist, enlarge, or spontaneously regress over time. Nodules on areas subject to pressure or trauma, such as the sacrum, have a greater tendency to ulcerate. Secondary infections of ulcerated rheumatoid nodules can lead to septic arthritis. Additional complications of rheumatoid nodules include pain, reduced joint mobility, and peripheral neuropathy.
In a poorly understood phenomenon, patients with RA treated with methotrexate and TNF-alpha inhibitors can experience an increase in the number and size of rheumatoid nodules.
Codes
ICD10CM:M06.30 – Rheumatoid nodule, unspecified site
SNOMEDCT:
33719002 – Rheumatoid nodule
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Subcutaneous granuloma annulare
- Tophaceous gout
- Calcium pyrophosphate deposition disease (pseudogout)
- Xanthoma, eg, xanthoma tendinosum (reveal foam cells on histology)
- Foreign body reaction
- Calcinosis cutis
- Myxoid cyst
- Lipoma
- Sarcoidosis
- Lymphadenopathy
- Mycobacterial infection (Mycobacterium marinum)
- Sporotrichosis
- Leukemia cutis
- Dermatomyositis
- Papulonecrotic tuberculid (see cutaneous tuberculosis; tuberculin test will show a positive reaction, and associated signs of pulmonary or extrapulmonary disease will be present)
- Necrobiosis lipoidica
- Erythema elevatum diutinum
- Bursitis
- Granulomatous infectious processes
- Granulomatosis with polyangiitis
- Malignancy
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/14/2019
Last Updated:02/28/2019
Last Updated:02/28/2019
Rheumatoid nodule in Adult