What Causes Rheumatoid Nodules and How to Treat Them

If you or a loved one has been diagnosed with rheumatoid arthritis, you may have noticed small, firm lumps forming under the skin. These are known as rheumatoid nodules, and while they’re not usually painful, they can be concerning, especially if they affect movement or comfort.

In this guide, we’ll explore what rheumatoid nodules are, why they form, who’s more likely to develop them and what treatments are available. We’ll also look at how supportive care at home can help manage the symptoms of rheumatoid arthritis and improve quality of life.

What are rheumatoid nodules?

Rheumatoid nodules are firm, round lumps that form under the skin, usually near joints affected by rheumatoid arthritis (RA). Most commonly, they appear on the elbows, fingers or forearms, but they can also develop in areas such as the heels, knees or even internal organs in rare cases.

They vary in size – from as small as a pea to as large as a walnut – and typically feel firm to the touch. While these nodules are usually not painful, they can cause discomfort if they press against nerves or restrict movement.

Why do rheumatoid nodules develop?

Rheumatoid nodules are a symptom of severe or advanced rheumatoid arthritis, an autoimmune condition that causes the immune system to mistakenly attack healthy joint tissues.

In people with RA, the immune system triggers inflammation in the joints, leading to pain, swelling and stiffness. Rheumatoid nodules form as a result of this chronic inflammation. They’re made up of inflammatory cells and dead tissue, which build up in response to ongoing joint damage.

Not everyone with rheumatoid arthritis will develop nodules, but several factors can make them more likely.

Risk factors for rheumatoid nodules

Some people are more prone to developing rheumatoid nodules than others. The main risk factors include:

• High levels of rheumatoid factor (RF): People who test positive for this autoantibody are more likely to experience severe RA symptoms, including nodules.
• Long-standing rheumatoid arthritis: Nodules are more common in individuals who have had RA for several years.
• More severe disease activity: The more active and aggressive the RA, the higher the likelihood of nodule formation.
• Certain medications: Interestingly, some drugs used to treat RA – such as methotrexate – have been associated with the development of nodules in some patients, a condition known as methotrexate-induced accelerated nodulosis.
• Smoking: Smoking increases the risk of both developing RA and experiencing more severe symptoms, including nodules.

Where do rheumatoid nodules appear?

The most common sites for rheumatoid nodules are:

• Elbows
• Fingers (especially the knuckles)
• Forearms
• Heels
• Knees
• Toes

In rare cases, nodules can also form internally, such as in the lungs or vocal cords, but this is uncommon and usually seen in people with more advanced disease.

Are rheumatoid nodules dangerous?

In most cases, rheumatoid nodules are harmless and do not cause pain. However, there are situations where they may become problematic:

• Infection or ulceration: If a nodule becomes irritated or breaks the skin, it may become infected or develop a sore.
• Nerve compression: Larger nodules can press on surrounding nerves, causing discomfort, numbness or tingling.
• Interference with movement: If a nodule forms in a joint that’s frequently used – like a finger or knee – it may restrict motion or cause awkwardness when performing daily tasks.

If a nodule becomes painful, inflamed or starts to change in appearance, it’s important to speak to a doctor.

How are rheumatoid nodules treated?

Treatment for rheumatoid nodules depends on their size, location, and whether they are causing any problems.

1. Medication adjustment

Since nodules are linked to disease activity, the first step is often to reassess RA treatment. A healthcare professional may:

• Adjust existing RA medication to better control inflammation
• Switch medications, especially if the nodules are linked to methotrexate use
• Introduce biologic drugs that target specific immune system processes

 

2. Steroid injections

If a nodule is painful or inflamed, a corticosteroid injection into the area may help reduce swelling and provide relief.

 

3. Surgical removal

In rare cases where a nodule causes significant discomfort or limits mobility, it may be surgically removed. This is usually a last resort and only recommended if the benefits outweigh the risks.

 

Can rheumatoid nodules go away?

With improved disease control, some nodules may shrink or disappear over time, especially if medication changes reduce the underlying inflammation. However, others may remain the same size or grow slowly. Not all nodules respond to treatment in the same way, so ongoing monitoring is important.

When to speak to a doctor

While rheumatoid nodules are often harmless, you should seek medical advice if:

• A nodule becomes red, swollen or painful
• The skin over the nodule breaks or becomes infected
• You experience tingling, numbness or reduced mobility around the area
• You notice new nodules forming quickly

Regular check-ins with your healthcare provider – especially during flare-ups – can help you manage the condition more effectively and catch any complications early.

How home care can help manage rheumatoid arthritis and nodules

Living with rheumatoid arthritis can be challenging, especially as symptoms progress or become more complex. Compassionate home care can make a big difference in managing the condition day-to-day.

Here’s how support at home can help:

Support with mobility and joint-friendly routines

Carers can assist with gentle exercises, walking aids and routines designed to ease joint stiffness, maintain movement and avoid excess strain on joints affected by nodules.

Help with daily tasks and meal preparation

Stiff or painful fingers and hands can make everyday tasks more difficult. Carers can help with cooking, dressing and using assistive tools, helping you or your loved one stay independent for longer.

Medication reminders and monitoring

Sticking to a medication schedule is vital for managing RA. Home carers offer friendly reminders and can keep an eye out for any signs that nodules or symptoms are worsening.

Skin care and hygiene support

If nodules are at risk of irritation or infection, carers can help with hygiene and skin checks to reduce the likelihood of complications and spot any early warning signs.

Find out how home care can support you or your loved one with arthritis in our helpful guide arthritis care at home.

Supporting your well-being at home

At Trinity Homecare, we’re here to support you or your loved one in managing the symptoms of rheumatoid arthritis in the comfort of home. Whether you need help with mobility, personal care or medication support, our compassionate team is ready to help you live life to the fullest – even with a long-term condition.

Call us now on 020 4572 5930 for a free, no-obligation consultation. Or if you’re enquiring outside of our opening hours, simply fill in our online form and we’ll get back to you the next day.