Arthritis nodules are lumps that can form under the skin or near joints in individuals with certain types of arthritis. These growths are collections of tissue that develop as a complication of the underlying inflammatory condition. Understanding their nature is the initial step in managing their presence effectively.
Understanding Arthritis Nodules
Arthritis nodules vary in characteristics, ranging from firm to soft and from movable to fixed beneath the skin. Their size can range from a pea to a walnut or even a lemon. They often form over areas subject to pressure or repeated trauma, such as the elbows, fingers, knuckles, and the backs of the heels.
Several types of arthritis are associated with nodule formation. Rheumatoid arthritis (RA) is particularly known for rheumatoid nodules, which are firm, non-cancerous lumps composed of dead skin cells, fibrin, and inflammatory cells. These can appear in about 20-25% of individuals with RA, typically over joints and pressure points, but can also form internally in the lungs or around the heart.
Osteoarthritis (OA), the most common form of arthritis, can lead to bony growths known as Heberden’s nodes and Bouchard’s nodes. Heberden’s nodes occur at the finger joint closest to the fingertip, while Bouchard’s nodes appear at the middle finger joint. These nodes are a result of cartilage breakdown and new bone formation.
Gout, another type of arthritis, can cause the development of tophi, which are deposits of uric acid crystals. Tophi are typically firm, often yellowish or white, and can occur in various locations, including toes, ears, and around joints. While many nodules are painless, they can cause discomfort or interfere with joint function, especially if they grow large, become inflamed, or press on nerves.
Medical Treatments for Nodules
Medical interventions for arthritis nodules aim to reduce their size, alleviate symptoms, or remove them. Surgical excision is an option primarily considered when nodules cause significant pain, interfere with daily activities, compress nerves, become infected, or ulcerate. However, nodules, particularly rheumatoid nodules, may recur even after surgical removal. Therefore, surgery is typically reserved for problematic cases after other treatments have been explored.
Corticosteroid injections treat inflamed or painful nodules. These injections deliver anti-inflammatory medication directly into the nodule, potentially reducing its size and tenderness. While effective for short-term relief, repeat treatments might be necessary due to their temporary nature. Potential side effects include skin discoloration or thinning at the injection site.
Systemic medications, particularly disease-modifying antirheumatic drugs (DMARDs) used for conditions like rheumatoid arthritis, play a significant role in managing the underlying disease and can indirectly affect nodule size. Controlling the inflammatory process of the arthritis can prevent new nodules from forming or limit the growth of existing ones. Certain medications, such as some biologic DMARDs, may even lead to a reduction in nodule size or prevent their progression.
Managing Nodules Conservatively
Conservative management strategies focus on alleviating symptoms and preventing complications associated with arthritis nodules, rather than directly removing them. Pain management techniques include over-the-counter pain relievers or topical creams applied directly to the affected area. These methods lessen discomfort caused by inflamed or irritated nodules.
Protecting nodules from pressure or trauma is another important conservative approach. This involves using padding, wearing comfortable footwear, or adjusting daily activities to avoid direct impact on the nodule. Nodules on the feet can make walking difficult, potentially leading to gait changes and pain in other joints if not properly managed.
Physical and occupational therapy helps maintain joint function and flexibility, especially when nodules interfere with movement. Therapists provide exercises to improve range of motion and suggest adaptive strategies for daily tasks. Lifestyle adjustments, such as applying heat or cold therapy or performing gentle massage around the nodules, offer symptom relief. Avoiding prolonged pressure on affected areas helps prevent nodule development or worsening. While these conservative measures do not eliminate the nodules, they are valuable for improving comfort and preserving functional ability.
When to Consult a Doctor
Seek medical advice if you notice new lumps or changes in existing arthritis nodules. Evaluation is advised if a nodule increases rapidly in size or changes its appearance. Signs of infection, such as increasing redness, warmth, swelling, or pus, warrant immediate medical attention.
Consult a doctor if nodules cause significant pain or discomfort that interferes with daily activities. Nerve compression symptoms, including numbness or tingling in the affected limb, also indicate a need for medical assessment. A healthcare professional can accurately diagnose the type of nodule and determine the most appropriate course of action.