What are they?
Rheumatoid nodules are growths
that develop over pressure points in patients with rheumatoid arthritis.
They frequently develop along or within tendons in apparent response to
pressure and friction. These nodular growths are soft tissue enlargements
that can vary in size from a small grape or marble to that of a walnut or
even larger. They are commonly located in the forefoot areas and often
involve the same areas of both feet. Rheumatoid nodules are usually not
painful to the patient but can cause other problems such as shoe wear
difficulties, gait and balance abnormalities, and cosmetic disturbances.
What causes them?
The disease process of
rheumatoid arthritis causes rheumatoid nodules. They are usually seen in
patients with well-established rheumatoid arthritis. As stated earlier, they
can enlarge over time and subsequently interfere with one's normal
ambulation and shoe use. Weight bearing pressure seems to be a primary
culprit as a cause for these growths since they frequently involve the
forefoot areas. Additional research however, will be necessary to identify
any confirmed causative factors.
How do you treat them?
The treatment for rheumatoid
nodules is reserved primarily for those cases where the patient is
complaining of pain, disability, or progressive growth of the lesion.
Specific care involves off-loading of the nodule to decrease pain, possible
steroid injections, physical therapy and various oral medications. Deep
molded shoes and accommodative orthotics can reduce the pain when walking.
Special care and precautions should be taken when injecting steroids into or
near tendons in order to prevent a weakening and/or rupture of the tendon
structure. In certain cases, surgical removal of the nodules is used but
with the understanding that there is a relatively high rate of occurrence.