Rheumatoid nodulosis is a variant of rheumatoid arthritis that follows a relatively benign clinical course. Some patients may present initially with nodulosis but develop typical rheumatoid arthritis over time.
Features of rheumatoid nodulosis:
(1) multiple rheumatoid nodules
(2) no or mild systemic manifestations
(3) no or little arthritis with no radiologic evidence of joint damage
(4) usually positive for rheumatoid factor (may be absent initially)
(5) variable subchondral bone cysts
Rheumatoid nodules may involve:
(1) elbows
(2) hands
(3) feet
(4) tendons (Achilles, other)
(5) sites subject to pressure
Differential diagnosis:
(1) gout
(2) tuberous xanthomas
(3) calcinosis cutis
Cholesterol crystals may be present in the rheumatoid nodules or affected bursae. These need to be distinguished from other forms of crystal deposition disorders.
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