Rheumatic nodules - Altmeyers Encyclopedia - Department Internal medicine

Synonym(s)

nodules rheumatici; Rheumatoid nodules

Definition
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Nodosus nodules and nodules belonging to the so-called rheumatism nodosus, which occur in 20% of patients with chronic polyarthritis (rheumatoid arthritis), mostly in severe forms, but occasionally without joint symptoms.

Localization
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Especially the ulnar area, elbows, hands, back of fingers, retroauricular region (also above the ears) are affected.

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Dermatology

Necrobiosis lipoidica

Rare, gynecotropic, idiopathic, eminently chronic, granulomatous systemic disease, which manifests itself o...

Clinic
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Indolent, skin-coloured, raised, hard, subcutaneous or in the soft tissues, up to hazelnut-sized, possibly ulcerated nodules.

Laboratory
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Often positive rheumatoid factors or positive antinuclear factors.

Histology
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In the deep dermis and the adjacent subcutaneous fatty tissue, map-like areas with homogeneous, eosinophilic degeneration of the collagenous connective tissue (fibrinoid necrosis), grouped nuclear remains, occasionally also calcareous material as well as palisade-like arranged histiocytes and giant cells surrounding the fibrinoid necrosis are impressive.

Differential diagnosis
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Heberden's knots

Juxtaarticular nodes

Xanthoma tendinosum et articulare

Gouty tophi

Rheumatic nodule

Granuloma anulare subcutaneum.

Therapy
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Treatment of the underlying disease, possibly excision or glucocorticoid crystal suspension intrafocally with triamcinolone acetonide (e.g. Volon A 1:3 diluted with local anaesthetics, e.g. scandicain).