What Are Arthritis Nodules? (Joint Nodules)

A woman with rheumatoid arthritis in her hands

Nearly 25% of people living with Rheumatoid arthritis experience something called arthritis nodules. Also called rheumatoid nodules or joint nodules, these fleshy, painless bumps can be seen on areas of the body where joints are most affected by arthritis. 

At first, these growths can appear unsightly, but the good news is that they’re often not as serious as they seem. They can be treated and usually go away on their own. Depending on the level of care received, they can become a persistent issue or occur several times a year.

What Are Rheumatoid Nodules?

Arthritis nodules are associated with the chronic inflammation condition called Rheumatoid arthritis (RA). This is a type of autoimmune disease where a person’s immune system wrongfully fights against its healthy joint and tissue cells. 

The main symptoms of rheumatoid arthritis are:

  • Ongoing joint pain
  • Stiffness in the muscles, joints, and tissues
  • Tenderness or pain in the body
  • Fatigue
  • Fevers 
  • Feeling achy or stiff throughout the day for more than 6 weeks

These main symptoms of RA can be painful and debilitating. However, the rheumatoid nodules themselves don’t typically cause pain. The main cause for concern in people who get joint nodes are unattractiveness and slight discomfort. 

a woman wth rheumatoid arthritis holding a cup of tea
Approximately 5% of people with rheumatoid arthritis develop joint nodules within two years of disease onset.

What Does an Arthritis Nodule Feel Like?

Rheumatoid nodules can feel squishy or firm. They can move around freely unless attached to deeper tissues in the joint, where they can feel stuck or hardened. Many people claim they feel like little balls of dough when touched. 

When it comes to size, arthritis nodules can be as small as a mustard seed or as large as stone fruit, like a plum or peach. They’re almost always round in shape but can sometimes be linear or deformed-looking. 

Are These Nodules Painful?

More often than not, arthritis nodules are not painful. Sometimes they can become sore or tender if they are attached to underlying nerves that are already inflamed, but the nodules themselves generally don’t cause any pain. 

Where Can Arthritis Nodules Develop?

Usually, joint nodules grow in areas of the body where frequently-used joints experience friction or pressure points with everyday movement. Sometimes they can develop where an individual’s body part touches a surface, such as on the tailbone of someone bedridden. 

Most often, Rheumatoid patients notice these nodules on their:

  • Elbows
  • Hands
  • Knuckles
  • Finger joints
  • Back of the heels (Achilles tendon)
  • Tailbone

In more severe cases, they can form in more areas of the body where you might not expect. These include:

What Causes Joint Nodules?

The causes of rheumatoid arthritis nodules aren’t specifically known at the moment. It’s something that causes a bit of scientific mystery, especially because these types of arthritis nodules aren’t often seen in other forms of arthritis. Psoriatic arthritis, osteoarthritis, and other rare forms of joint-related immune system disorders don’t cause nodules. 

One thing that is known to contribute to the forming of arthritis nodules is a type of medication called methotrexate. Many people with RA are prescribed this medication to help their immune system slow down and not worsen the painful symptoms of RA.

If methotrexate is the main risk factor in rheumatoid nodules, the doctor will switch antirheumatic drugs to something like rituximab.

What Are Rheumatoid Arthritis Nodules Made Of?

As these growths affect someone with RA on the dermis level (having to do with the skin), studies have shown that they are made of several different elements. 

Dead skin cells: Old, dead protein cells in and on the body can build up and accumulate in the nodules.

Fibrins: Associated with blood clotting and tissue repair, sometimes fibrins are found in RA nodules.

Inflammatory tissues: As stated, rheumatoid arthritis is an inflammatory joint disease which means excess antibodies can build up and cause RA nodules. 

Who Gets Joint Nodules?

Some rheumatoid arthritis cases are diagnosed because of an observable onset of rheumatoid nodules. They can sometimes be mistaken for cysts, bursitis, tumors, or more serious skin conditions. Taking other symptoms into account can help a doctor properly diagnose the actual disorder. 

People most likely to get arthritis nodes are:

  • Those who have a severe form of Rheumatoid arthritis (RA)
  • People with RA who smoke cigarettes
  • Someone with a family history of RA
  • Women with RA (more likely to develop in females)
  • RA patients who are bedridden
  • A patient with arthritis who takes the prescription medication methotrexate
  • People who work with their hands a lot while having Rheumatoid arthritis
A needle biospy questionnaire.
A skin biopsy may be needed to confirm arthritis nodule diagnosis.

How Are They Diagnosed? 

Most of the time, people who already have a diagnosis of rheumatology can be easily diagnosed with joint nodules once they start to appear. 

Some patients have a higher rheumatoid factor, which means there are higher amounts of proteins in their body that actively attack their healthy joint cells. This means their symptoms are likely more painful and ongoing. People with a lower rheumatoid factor could have few symptoms or be asymptomatic.

If the person doesn’t know they have arthritis, a rheumatologist will be able to diagnose properly. They might do a biopsy of the nodes which can help them give medical advice.

Symptoms of Arthritis Nodules:

  • Small to large masses of growth on the skin near joint areas
  • Numerous nodes forming in one area (AKA Accelerated Nodulosis)
  • Typically round but sometimes oddly shaped or linear
  • Able to be moved around loosely under the skin
  • Rubbery, squishy, or firm lumps
  • Bumps or lesions that lack ulceration (they don’t cause open wounds or drainage)
  • Existing or co-occurring diagnosis of rheumatic diseases
  • Other skin conditions like psoriasis or vasculitis have been ruled out

Treatment for Rheumatoid Arthritis Nodes

In most instances, RA nodules don’t require treatment. They likely go away on their own over time. They can come and go depending on the flare-up of symptoms in patients whom arthritis affects.

Sometimes, though, these nodules can inhibit movement and comfort. If a nodule is too large, like the size of a lemon, corticosteroids can be injected to shrink the size. Surgical removal is also an option to treat some nodules, if necessary. 

If a person with RA has ongoing joint nodules that debilitate them, they often seek at-home care or assisted living. A caregiver can help improve their health and lifestyle needs while living with rheumatoid arthritis symptoms. 

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