Two cases of rheumatoid nodules developing on the fingers in patients with rheumatoid arthritis

Ayako Ijichi, Chikage Mitoma, Yumi Yasukochi, Hiroshi Uchi, Masutaka Furue

Research output: Contribution to journalArticlepeer-review


Cutaneous or subcutaneous nodules often develop in patients with rheumatoid arthritis (RA).Case 1.A 76-year-old female, diagnosed with RA in 2003, had taken tacrolimus, prednisolone, and salazosulfapyridine.In 2013, subcutaneous nodules developed on the bilateral thumbs.Case 2.A 66-year-old female, diagnosed with RA in 2005, had taken methotrexate (MTX).Two months after the start of etanercept therapy addition to MTX for active RA, a reddish nodule developed on the dorsal surface of the left fourth finger.Histological examination of the nodules of both cases showed palisading granuloma accompanied by fibrinous degeneration of collagen fibers in the dermis.We diagnosed these cases as rheumatoid nodules (RNs) developing in patients with active RA.RNs occur in approximately 25% of patients with RA, most commonly in active and severe RA.Besides the well-known concept of MTX-induced accelerated nodulosis, which develops frequently on the fingers with a sudden onset during MTX therapy, several cases have recently been reported of nodulosis under anti TNF-α biologic therapy, mostly etanercept, for RA.We report here two cases of RNs on the fingers, in one of which the association of MTX and etanercept with the formation of the nodule could not be denied.We also describe the differences between RNs and drug-induced accelerated nodulosis and the possible pathogenesis with some literature review.

Original languageEnglish
Pages (from-to)362-366
Number of pages5
JournalNishinihon Journal of Dermatology
Issue number4
Publication statusPublished - 2016

All Science Journal Classification (ASJC) codes

  • Dermatology


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