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The Scourge of Rheumatoid Nodules

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My personal history of rheumatoid nodules began several years ago when my “then” primary care doctor wanted me to have a stress test.  I reminded her of my claustrophobia and refusal to climb into that MRI machine.  She suggested a CT Heart Scan instead.  She explained that the scan part of this test runs you in and out of the machine with no lengthy time inside of it, and it doesn’t touch your body in any way.  After much discussion, I agreed. Test completed, the tech called in another lady to observe what she viewed.  They whispered back and forth and shook their heads but told me nothing. I overheard the words, “lung tumors.”

A Long Week of Waiting

A week later, my doctor’s office called and wanted me to come in the next day and meet with the physician’s assistant, because my doctor was out of town.  Yes, I was concerned. My mind raced with visions of lung tumors and cancer in my future.

This guy met me with a glum face and proceeded to tell me that I had a real problem: My lungs were “riddled” with tumors.  Heart looked fine, but he considered it imperative that I immediately see a pulmonary specialist he recommended. Contrarian that I can be, I requested more information before seeing another doctor.

Somehow, I just knew this made no sense and asked more questions.  He really didn’t want to answer any of them.  Finally, I told him I would choose my own doctor and if there were a suspicion of cancer, I would prefer to go to Tampa to Moffett Cancer Center.  This P.A. shook his head, stood up and came over to pat my shoulder and said, “I am so very sorry.”

I drove home, thinking this doesn’t make sense and I’m not sick. If my lungs were full of tumors, I’d have symptoms. I felt no fear, just puzzled.

I made an appointment with a lung cancer specialist at Moffett and spent days studying the subject and still doubted the diagnosis.  The doctor at Moffett came in and told me he had no idea what the scan showed, but he had never seen any tumor of the lung that looked like this.  I left there, without a diagnosis but relieved it wasn’t the big C.

Doing What I Should Have Done

The next day I called my rheumatologist’s office. I should have called him first!  He read the CT report, viewed the CD and told me the abnormalities in my lungs were rheumatoid nodules, not actual tumors.  He asked me if I had any symptoms of chest or breathing issues and said there was no telling how many years the nodules had been present.  They don’t show up on X-Rays, and this was my first scan that involved my lungs.  He recommended I wait a year and get another CT scan, which I did.  It showed no changes.  Now, with no symptoms, I ignore the nodules.

Previous Signs of Rheumatoid Nodules

For 30 + years, I’ve experienced an annoying cough at times.  It isn’t deep, involves sinus drainage, and I attributed it to allergies.  Perhaps this was a “symptom” of my lung nodules.  Who knows…

What Are Rheumatoid Nodules?

These nodules are firm lumps that show up under the skin in as many as 20 – 25% of RA patients.  They are usually painless and rarely require any treatment.  However, they are often large and unattractive.  Rheumatoid nodules may be a sign of heightened disease activity.

Possible Causes of Nodules

Uncontrolled rheumatoid disease produces an increased risk of developing nodules.  Patients who smoke are more likely to develop rheumatoid nodules, and genetics may predispose them to the nodules.

6 Reasons Why Treatment Might Become Necessary

In many cases, finding the correct medications to control the progression of rheumatoid arthritis helps treat the nodules.  They may shrink or even disappear. 

If the nodule is located in a tender spot, such as the heel that would make shoes painful to wear, treatment or removal might be necessary.

In rare cases, a patient taking Methotrexate might develop multiple nodules, requiring a change in medication.

If a nodule presses on a nerve, that could limit mobility and become quite painful and need to be removed.

Certainly, the nodules can become unsightly.

For RA patients with lung problems or vasculitis, nodules are more common.

Talk to Your Doctor About Your Rheumatoid Nodules

Your doctor can best advise you if your nodules need treatment or even surgery of any kind.  The medical profession doesn’t know the exact cause of the nodules and cannot explain why some disappear and some don’t. But they can help you understand the best way to deal with them.

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