Nodules in RA

 Q: 32 years old female with a known history of Rheumatoid Arthritis (RA) is admitted to ICU with septic arthritis. Patient is found to have rheumatoid nodules at pressure points on the skin examination. Presence of nodules is a bad prognostic sign in RA.

A) True

B)False

Answer: A

Patients who exhibit rheumatoid nodules usually have a severe RA phenotype. They tend to have rapid progression of joint destruction. Unfortunately, these patients may develop nodules in internal organs too, and have higher risk of hospitalizations, vasculitis, Felty syndrome as well as pulmonary, cardiovascular and all-cause mortality.

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References:

1. García-Patos V. Rheumatoid nodule. Semin Cutan Med Surg 2007; 26:100. 

2. Nyhäll-Wåhlin BM, Turesson C, Jacobsson LT, et al. The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years. Scand J Rheumatol 2011; 40:81. 

3. Kaushik P, Solomon DH, Greenberg JD, et al. Subcutaneous nodules are associated with cardiovascular events in patients with rheumatoid arthritis: results from a large US registry. Clin Rheumatol 2015; 34:1697.