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Accelerated rheumatoid nodulosis

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Accelerated accelerated rheumatoid nodulosis is a skin condition where there are nodules formed on the skin, especially in the lower extremities.

Rheumatoid nodule
Rheumatoid nodule

What are rheumatoid nodules?

Rheumatoid nodules are characterised by subcutaneous nodular lesions that develop in pressure areas, such as finger joints and the extensor area of the forearm. The nodules are typically small and concentrated on the extensor sites of the hands and feet, sometimes accompanied by bone erosions. The onset typically starts in adulthood with a pathology similar to rheumatoid arthritis associated rheumatoid nodules.

Rheumatoid nodule
Rheumatoid nodule

Incidence

Rheumatoid nodules occur in approximately 30–40% of patients with rheumatoid arthritis (RA).

Significance

Rheumatoid nodules reflect high levels of disease activity and severity of rheumatoid arthritis.

Diagnosis

Diagnosis is clinical along with blood tests for rheumatoid arthritis and biopsy of the skin.

Treatment

  • Treating the underlying cause, rheumatoid arthritis, with disease modifying agents.
  • As TNF-α level is low in nodules, rituximab and other options as opposed to anti-TNF drugs in those with accelerating nodulosis.
  • Also, as IL-1β is high in nodules, treatment with IL-1β inhibitors could be suggested as an option

Differential diagnosis

RA patient with accelerated nodulosis that started with the use of methotrexate and exacerbated with etanercept and leflunomide treatment.


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