Should I get my rheumatoid nodules removed?
I've read that sometimes nodules can disappear and reappear. How do I know when I should have them surgically removed? What are the pros and cons of removal versus living with the nodules?
Answers from our Doctors
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.
I have been living with severe RA since I was 25 years old, I'm 62 now--a long time! I have several nodules mostly on the PIP joints of my fingers. Some of them are very painful especially the one on my left ring finger. I bump that one all the time and the pain is excruciating. I would love to have that one and perhaps a couple of others surgically removed. I'm aware that they could come back but I'm willing to take that chance. Is this a foolish idea?
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 truely 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 possbile recurrence of rheumatoid nodules, it depends on several factors. Hopefully, your are being followed by a rheumatologist. If not, your 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 resonable 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
Thank you so much, Dr Biundo, for your answer regarding surgery to remove some of my RA nodules. Yes, I am being followed by a rheumatologist and have been for many years. I took Plaquenil for 3-4 years but went off of it several years ago-- I don't even remember why. Perhaps I should speak to my rheumatologist about taking it again. Thanks again for your advice.
to use on them?
Also should I be seeing a rheumatologist on a reg basis?
I used the Valtaren gel for RA, my family doctor recommended it not my Rheumatologist. The medicine works great, no pain at all. However I had an allergic reaction from it, massive migraine, vomiting, slurred speech, swollen throat. I was so sick I could not even go to the doctor. I don't know if I had an allergic reaction or a drug interaction. I think the only reason I survived it was that I did not take the full dose. I am still recovering now after 24 hours. I washed off all of the gel and drank strong coffee to open my throat. I will only get medicines from my Rheumatologist from now on.
I wanted to add he prescribed it also for broken toes. I was taking it as an alternative to narcotic pain medicines. He wrote me a larger prescription to use on my RA also.
I have prescribed Voltaren Gel for various problems, and I think that it is best suited to treat osteoarthritis of the hand. The joints involved are the distal interphalangeal joints, the proximal ones, and the joint at the base of the thumb. These are superficial joints and have a better chance of good abosrption of the gel than deeper joints, such as knee, shoulder or hip. I rarely have used it in RA, as I try to control the overall inflamation in RA with Methotrexate, Plaquenil or, if needed one of the biologic drugs.
Injection of the basal thumb joint - first carpometacarpal - with lidocaine and a corticosteroid is often beneficial.
Joseph J. Biundo, MD
I HAVE ARTHERITS IN MY HANDS . HOW CAN I GET A PERSCRITION FOR VALTAREN GEL?
try going to your doctor.
I ran across this post from a google search. I too, have the same problem, nodule on my left ring finger, and under my right thumb. the one on my ring finger, is just as described here. I was curious to know if the poster- had the nodules removed and how was the outcome?