If you have rheumatoid arthritis, have you ever noticed a small lump or bump under the skin in places like your elbows and knuckles? Some people are a little scared when they see these, thinking, "Is this something serious?" But don't worry. These are usually not dangerous. Today we're talking about these special lumps that come with rheumatoid arthritis, called rheumatoid nodules.
What are these rheumatoid nodules?
Simply put, rheumatoid nodules are small lumps that develop under the skin or sometimes inside the body when you have rheumatoid arthritis (RA). In medical terms, we refer to a 'nodule' as a lump that is usually smaller than an inch (about 3 millimeters).
The important thing is that these lumps are not cancerous (benign). Having them does not mean that you have cancer or that you will develop cancer in the future. So don't worry about it.
These lumps are made up of a bunch of cells that have clumped together. That means:
- Dead skin cells
- Fibrin cells (these are a strong protein that helps blood clot)
- Inflammatory cells in your immune system
These cells come together to form that little lump-like lump.
Where on the body do these lumps most commonly occur?
These bumps usually form around the joints that you use the most during your daily activities and that are subject to frequent stress. Let's take a look at the most common and least common places where they can be seen.
| Where lumps are most commonly seen | Rarely lumps (inside the body) |
|---|---|
| Elbow | Pulmonary nodules |
| Fingers and toes | The white part of the eye (sclera) |
| Forearms | Vocal cords |
| Near the heel or Achilles tendon | - |
| In relation to the hip bone | - |
| Lower back (Sacrum) | - |
| Skull (especially in bedridden patients) | - |
How do these lumps feel in the hand? Is there any pain?
When you touch these lumps, some may feel hard, like a small pebble stuck under the skin . Others may feel a bit soft, like a stress ball, and may feel like they can be crushed .
In terms of size, these can range from lumps as small as a pencil eraser to, very rarely, lumps as large as a computer mouse.
The important thing is that these lumps are usually painless. However, you may feel pain and tenderness when you press on the area around the lump. This tenderness may be more noticeable if the lump is near a joint where your arthritis is already severe.
You can't feel lumps that develop inside your body, like in your lungs, eyes, or vocal cords. They're often discovered incidentally during an X-ray or eye exam done for another reason.
Why do these rheumatoid nodules form?
The same thing that causes you to have rheumatoid arthritis also causes these lumps to form. That is, it is due to an autoimmune response in your immune system .
But not everyone with RA develops these lumps. Doctors estimate that between 25% and 40% of RA patients may develop these lumps. And less than 1% of people develop lumps in places like the lungs and eyes.
In RA, your immune system attacks healthy joints, causing inflammation. This inflammation causes the joints to swell and become painful. When the immune system becomes overactive, it can also affect other tissues in the body.
Imagine you're a carpenter or a typist. Your hands and fingers are used all the time. So if you have RA, you're more likely to develop these lumps around your frequently used joints.
People with high levels of Rheumatoid Factor or CCP antibodies in their blood are at increased risk of developing these lumps. Your doctor can measure these with a simple blood test.
What are the treatments to get rid of these lumps?
Sometimes these lumps don't need any treatment. They can form and disappear on their own, just like RA symptoms can flare up some days and subside some days.
How long a lump lasts depends on where it forms, the stage of your RA, and your overall health.
However, if the bumps are painful, don't go away on their own, or if their appearance is affecting your self-confidence, your doctor will prescribe treatment.
Commonly used treatments:
- Corticosteroids: These are a type of medication that reduces inflammation. Sometimes your doctor may give you a cortisone shot right next to the lump.
- DMARDs (Disease-modifying antirheumatic drugs): These medications control the overactivity of the immune system and reduce inflammation in the body.
- NSAIDs: These are also painkillers that reduce inflammation. Your doctor will recommend the right type for you.
- Monoclonal antibodies: These are artificially made antibodies. They help regulate the immune system. An example is the rituximab injection.
Do these lumps need to be surgically removed?
Surgery is not usually necessary, but your doctor may recommend surgery in the following cases:
- If the lump is on or near an organ inside the body, and it has not gone away on its own.
- If the lump is very large in size.
- If the lump does not go away despite trying other treatments.
- If these bumps make it difficult to use the limb or perform daily activities (e.g., if you constantly bump into something).
What time should I see a doctor?
If you notice any new changes, lumps, or bumps on or under your skin, be sure to see a doctor and get it checked out.
If you're already being treated for RA and feel like your medication isn't working as well as it used to, tell your doctor about that too.
It's normal to be surprised and a little scared when you see a new skin lump. But the good news is that rheumatoid nodules are usually harmless and often go away without treatment. Even if treatment is needed, most of it is the same treatment you're already using for RA.
The most important thing is to have any new lump checked by a doctor. This is the safest way to know for sure whether it's a rheumatoid lump or something else.
Also, if these lumps are interfering with your daily activities or hobbies, or if you are concerned about your appearance, talk to your doctor about that as well. He or she will explain to you the options for reducing or removing them.
Take-Home Message
- Rheumatoid nodules are a type of non-cancerous lump that occurs in association with rheumatoid arthritis (RA).
- These most commonly occur near frequently used joints such as the elbows and fingers, but can rarely develop in internal organs such as the lungs.
- These are often painless, but it is important to have any new lumps checked by a doctor.
- Treatment is not always necessary. Some lumps go away on their own. But if they are painful or troublesome, there are effective treatments.
- Talk openly with your doctor about any new changes or lumps you notice on your skin.
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