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A rheumatoid nodule is a lump of tissue, or an area of swelling, that appears on the exterior of the skin usually around the olecranon (tip of the elbow) or the interphalangeal joints (finger knuckles), but can appear in other areas. [1]
The redness starts to fade and it gradually becomes softer and smaller until it disappears. Each nodule usually heals completely without scarring over the course of about two weeks. [3] [4] Joint pain and inflammation sometimes continue for several weeks or months after the nodules appear. [5] Less common variants of erythema nodosum include:
About 20% of people with rheumatoid arthritis develop rheumatoid nodules, which are linked to more severe erosive disease in those patients. [2] The nodules are more common in men, typically manifest in the fifth decade of life, and are primarily found on extensor surfaces like the backs of the fingers and elbows, though they can occur anywhere.
The most commonly accepted probable cause of ganglion cysts is the herniation hypothesis, by which they are thought to occur as an out-pouching or distention of a weakened portion of a joint capsule or tendon sheath. This description is based on the observations that the cysts occur close to tendons and joints.
They are seen in osteoarthritis, where they are caused by the formation of calcific spurs of the articular (joint) cartilage. Much less commonly, they may be seen in rheumatoid arthritis, where nodes are caused by antibody deposition to the synovium. A Bouchard's node on the proximal interphalangeal joint of the index finger of a 64 year old man.
Heberden's nodes typically develop in middle age, beginning either with a chronic swelling of the affected joints or the sudden painful onset of redness, numbness, and loss of manual dexterity. This initial inflammation and pain eventually subsides, and the patient is left with a permanent bony outgrowth that often skews the fingertip sideways.
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Another form the rash takes is called Gottron's sign, which is red or violet, sometimes scaly, slightly raised papules that erupt on any of the finger joints (the metacarpophalangeal joints or the interphalangeal joints). [8] [9] Gottron's papules may also be found over other bony prominences including the elbows, knees, or feet.