What to do with rheumatoid subcutaneous nodules

Beautician is a joint disease, and the pain of rheumatoid arthritis is very unbearable. Many patients have rheumatoid arthritis, so this is why young people are required to keep warm in normal times, because once you have rheumatoid arthritis, it is difficult to treat. The occurrence of rheumatoid arthritis will not only cause joint deformation and pain, but most importantly, there will also be rheumatoid subcutaneous tissue nodules. What should I do with this symptom?

Rheumatoid nodules are often seen when rheumatoid arthritis is highly active, the erythrocyte sedimentation rate continues to increase, and RA is positive. It is one of the criteria for diagnosing rheumatoid arthritis and determining the activity of the lesion, and indicates a poor prognosis.

The incidence of rheumatoid subcutaneous nodules is approximately 5% to 25%. Its size is about 0.2 to 5 cm, like lentils, peanuts, cobs or walnuts, and is round or oval in shape. It is usually as hard as rubber or bone, painless and movable. However, if it is located under the periosteum and adheres to the aponeurosis or joint capsule, it will become immobile and the epidermis will be normal. The number ranges from one to dozens. It can appear alone, but is usually distributed symmetrically.

It is more common around joints, especially the olecranon bursa of the elbow, the subcutaneous or subperiosteal location of the ulna shaft, and the surface of the forearm extensor muscles; it is less common in the sternum, shoulder, ischial tuberosity, ribs, Achilles tendon, occipital tendon or subperiosteal location of the head, larynx, back and calf, as well as the helix and bridge of the nose. If it appears in these locations, it may be as hard as a bony protrusion and fixed and immobile, and is often misdiagnosed as a bone tumor.

Sometimes small nodules can be felt on the heads of the 1st and 2nd metatarsal bones, beside the wrist bones, and on the extensor surface of the tibia. Typical rheumatoid nodules also often occur in the synovium, muscles, tendons, tendon sheaths, lymph nodes, deep myocardium, endocardium, epicardium and base of the mitral valve, blood vessel walls, posterior pharyngeal wall, sclera, nerve fibers, adrenal cortex, lungs, liver, spleen, kidneys, intestines, pleura, pericardium, peritoneum, meninges and spine, and cause a series of symptoms.

Larger rheumatoid nodules may calcify after adhesion to the periosteum, causing periostitis. Secondary infection of rheumatoid nodules in soft tissues and tendons can cause lymphangitis, cellulitis, and sepsis. The nodules will necrotize and form ulcers that are difficult to heal. RA ulcerative subcutaneous nodules on the bridge of the nose are easily misdiagnosed as basal cell tumors, which can be confirmed by biopsy.

Rheumatoid subcutaneous nodules are also seen in connective tissue diseases such as allergic subsepsis, Jaccoud arthritis, ankylosing spondylitis, SLE and scleroderma. Rheumatoid nodules can disappear quickly after hormone treatment.

Care should be taken to distinguish nodules of the following diseases that can be easily confused with rheumatoid nodules:

1) Rheumatic subcutaneous nodules: They usually appear in batches and disappear within a few days or weeks; while rheumatoid nodules appear mostly or symmetrically in a small number and last for days or even years.

2) Gout nodules: They are often located in the auricle. After rupture, yellowish tofu-like material (urate crystals) may be seen in the shell, and fistulas may sometimes form. Rheumatoid nodules rarely occur in the auricle and are harder than gout nodules and rarely rupture. Special attention should be paid to distinguishing them from tophi near joints.

3) Herberben nodes of osteoarthritis: often located at the distal phalanx joints, hard and bone-like, with marginal hyperplasia at the epiphysis of the distal phalanx (toe).