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A rheumatoid nodule is a lump of tissue, or an area of swelling, that appears on the exterior of the skin usually around the olecranon (tip of the elbow) or the interphalangeal joints (finger knuckles), but can appear in other areas. [1]
About 20% of people with rheumatoid arthritis develop rheumatoid nodules, which are linked to more severe erosive disease in those patients. [2] The nodules are more common in men, typically manifest in the fifth decade of life, and are primarily found on extensor surfaces like the backs of the fingers and elbows, though they can occur anywhere.
Rheumatoid arthritis is a primary cause of swan-neck deformity due to the presence of inflammation of the joints. [11] Additionally, swan-neck deformity can be caused by weakening or tearing of the ligament and tendon on the middle joint of a finger. [ 10 ]
Rarer causes which usually behave differently but may cause joint pains: [88] Sarcoidosis, amyloidosis, and Whipple's disease can also resemble RA. Hemochromatosis may cause hand joint arthritis. Acute rheumatic fever can be differentiated by a migratory pattern of joint involvement and evidence of antecedent streptococcal infection.
Heberden's nodes typically develop in middle age, beginning either with a chronic swelling of the affected joints or the sudden painful onset of redness, numbness, and loss of manual dexterity. This initial inflammation and pain eventually subsides, and the patient is left with a permanent bony outgrowth that often skews the fingertip sideways.
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