I have multiple rheumatoid nodules and I have had several surgicaly removed.Lately more have developed.I have multiple rheumatoid nodules and I have had several surgicaly removed.Lately more have developed.

They tend to become infected. Should they be removed regularly?

Answers from our Doctors

RheumMD Admin says:

Here is a previous answer and comment supplied by Dr. Joseph Biundo to the question "Should I get my rheumatoid nodules removed?" that relates to your question:
Dr. Joe Biundo says:

The answer depends upon the circumstances which includes the size of the nodules, the number of nodules, whether symptoms result from the nodules, the cosmetic aspect and the current treatment. In general, the nodules are not surgically removed. Some medications used to treat RA do tend to decrease the size while others do not. Hydroxychloriquine at a dose of 200 mg. twice a day, in my experience, does help in decreasing the size. When gold salt injections were used in the past, they too seemed to decrease the size. However, methotrexate does not seem to have any benefit. I am not sure how well the biologic drugs (tumor necrosis factor inhibitor drugs) work in this regard. So, with my patients I would definitely prescribe hydroxychlorine and observe over a 12 month period to see the results, and would be inclined to continue the drug even if the nodules are not markedly improved. If the nodules are extremely large, and not responding to treatment, then excision is an option.

No, it is not unrealistic to try to have a nodule or two surgically removed. First, you need to make sure that the sites involved are truly rheumatoid nodules and not a bony nodule. I would suggest seeing a hand surgeon for an evaluation to see what can be done surgically. In regard to possible recurrence of rheumatoid nodules, it depends on several factors. Hopefully, your are being followed by a rheumatologist. If not, you should consider doing so.

If the level of rheumatoid factor is very high in you blood, there is a greater chance for recurrence. Yet, there is a reasonable possibility that, especially if you have been on good treatment for RA, that the nodules will not recur or, if so, would develop very slowly over years. Too, I have had the experience that treatment with Plaquenil helps prevent rheumatoid nodules from developing and can even help reduce the size.

Joseph Biundo, Md

Answered on: Tuesday, September 14, 2010 - 16:14

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