Nodules

[KaysDad]

I developed RA back in 2003 - diagnosed in 2004. Like many, I developed nodules on my forearm just distal to the elbow and on top of the fibula, first one, then two, which became hard and then a third soft one actually on the elbow. I was put on a trial of Rituximab, after having failed on 3 DMARDS. Three sessions of RTX put me into remission by 2008 and, surprisingly, my nodules were reabsorbed. At the end of last year and the beginning of this my RA came back together with 1 nodule and I was given another RTX treatment - once the magic NICE criteria had been met, of course - and I am fine again. I think that the nodule is going, but I am not sure yet. My question is, what are the nodules and what actually causes them? All I can find out via Dr Google is that they are associated with RA and are benign but what causes them? (RA is not a good enough answer!!)

[nomoreheels]

Don't know if you've seen this or if it's of any more help than what you may have already researched? nras.org.uk/rheumatoid-nodules

[helixhelix]

From a book on RA....

"Rheumatoid nodules are the most frequent skin manifestations (20%) in RA. They occur mainly in rheumatoid factor positive RA patients and in early RA give risk to severe extra-articular manifestations. Histologically focal central fibrinoid necrosis with surrounding fibroblasts is observed: it is believed to occur as a result of small vessel vasculitis. "

What I take from that is that if your inflammations spreads from your joints into your blood vessels (ie vasculitis) then the nodules are basically the equivalent of your joints getting inflamed synovial fluid....

[flow4]

My understanding is that there are different types of nodules, but I might be wrong...

There are bony ones, which are like the osteophytes that grow in OA - the bone trying to defend itself from erosion by growing extra bits.

There are fibrous ones, usually on/around tendons - again a defense response to damage and inflammation, but in soft tissue rather than bone. enthesis.info has info about these.

There are vascular ones, where the blood vessels get inflamed and their walls thicken, basically like a pipe clogging up. These are the ones which can be reabsorbed, I believe.

I had lots of tiny nodules - about pea-size or split-pea-size - before I started treatment. 2-3 weeks after an intra-muscular steroid injection, some of them started to vanish.

[KaysDad]

Thanks, nomoreheels. Yes, Google did throw that one up but it didn't explain what they were or why they happened.

That is more explicit, helixhelix.

That deals with the two observed types, flow4, but back in 2006-8, my 3 started off as soft & 'squidgey' but 2 hardened into more solid ones, rather bone-like in feeling, just as my current one is. Interetsting how they find a fairly common location to form, though.

[flow4 in reply to KaysDad]

Those sound like they're 'cartilaginous' - I think they start soft and become harder and more bony as they get older. (Think of a chicken wishbone drying out and you get the idea!) I've tried to find the link that told me that but I can't; it may have been that enthesis.info website...

[moomie]

I found this interesting. I have what I thought 2 spots/ lumps on my elbow. Sometimes they look red other skin colour. Asked the Dr at clinic a few weeks ago and he said wasn't sure if RA nodules. Also a couple of months ago had red pin point rash on my legs he said this was part of the arthritis.

I think I find out more from you people than the Reg I see.

Hope your infusion works well for you.

[flow4 in reply to moomie]

Oh that's interesting; I had a pin point/mottled rash when I was flaring a couple of months ago.

[moomie in reply to flow4]

The Dr said it was vasculitic. It disappeared after about 10 days. I was just changing to mtx injections at the time.

[WadeTate]

Hi Richard,

My first experience with nodules happened at the very beginning of my disease process (RA.)I found a lump on my bicep tendon behind my elbow and it frightened me to death.

At the time I had no idea what was going on and thought I had cancer.

Since then I've been through a 12 year natural RA journey and removed all of these things from my tendons.

Moving to an organic diet and cutting sugar, bread, cake, alcohol and all the rest eventually let my tendons get back to health, but it didn't stop the nodules forming.

I exercised a lot to try and restore health, but I still developed nodules in my heels despite my spotless diet. Some of these things were as big as your thumb end!

Some nodules formed due to tearing them with exercise and the residual RA inflammation as I forged ahead doing more exercise than I perhaps should of.

To fight this pain I was taking a lot of ibuprofen, which has been suggested can have negative effects on connective tissue.

ncbi.nlm.nih.gov/pubmed/216...

It is possible there is a connection between calcium retention in tissues, ibuprofen, bad diet and fibrin but research is slow on this.

tandfonline.com/doi/full/10...

anatomy-physiotherapy.com/a...

The only nodule I have left is the original one by my elbow tendon but that gets smaller and softer by the year and is on it's way out.

Not bad considering I had that thing for 8 years before I found something to treat it with.

I got my info from here:

serrapeptase.info

Three things helped me stop this happening to my body. Giving up ibuprofen, taking serrapeptase, and continuing my healthy organic diet.

Please do your research on these and remember that my experience is with tendon fibroids. I have bone deformity and joint damage but I haven't developed any really extreme bone related nodules for a time.

The ones I did form during my early RA experience were removed by taking out dairy and bread, cakes and inorganic calcium from my diet.

Inorganic calcium cannot be assimilated by the body and builds up in the joints, muscles, and tendons.The body has to shunt it somewhere to protect the organs. Calcium also contributes to the tendon nodule problem i spoke of above because it is deposited in the connective tissue and muscles where those two things join, making proper strong repairs impossible.

rad.washington.edu/academic...

You can remove some of this with things like MSM, zeolites, better sources of calcium but here's a great video of how to proceed.

Check it out and have fun!

youtube.com/watch?v=UUNg4Hy...(Not working as expected?)

Best of luck,

Wade Tate

[KaysDad]

Thanks for the references, wade. And for the other comments provided by members.

Just for an update, my nodules does now seem to be shrinking, probably due tomthe Rituximab infusion in June.

[WadeTate in reply to KaysDad]

Hi Richard,

Thank you! Hope it helps.

Due to me not having lots of spare time I'm going to try and answer as many questions as I can on this forum but I won't be able to answer them all. Please check my other replies out because I'm going to drop some real arthritis gold nuggets on this forum in the future.

I posted some great videos in this thread earlier and hope you can find benefit from them?

Have a great pain free day and chat soon.

Best wishes,

Wade