They occur more often in men than in women and usually are seen in smokers with subcutaneous nodules and high rheumatoid factor titers.
Many patients can be asymptomatic. Rheumatoid pulmonary nodules can arise before rheumatoid arthritis is manifested clinically or may develop concurrently.
On histology, they appear identical to the nodules found in subcutaneous tissue. Necrobiotic nodules also can occur in lung before clinical arthritis develops or even the absence of rheumatoid factor
Rheumatoid nodules tend to be located in the periphery of the upper and middle zones.
Not very sensitive (may only be detected a very small proportion of cases on plain film) 5.
On HRCT or CT of the chest:
- nodules can be quite variable in appearance 5
- associated cavitation may be seen
- may be single or multiple
- size ranges from 0.5-7 cm 3,5
- rarely these nodules can have associated calcification
- tend to be peripheral, subpleural or pleural 8
CT-PET may demonstrate false positive FDG-18F avidity 7.
Treatment and prognosis
Their natural history follows an unpredictable course. These nodules may undergo cavitation, increase in size, or resolve spontaneously over time. Their course often has no relationship to the course of the rheumatoid arthritis.
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- 4. Kitamura A, Matsuno T, Narita M et-al. Rheumatoid arthritis with diffuse pulmonary rheumatoid nodules. Pathol. Int. 2004;54 (10): 798-802. Pathol. Int. (full text) - doi:10.1111/j.1440-1827.2004.01758.x - Pubmed citation
- 5. Patel R, Naik S, Amchentsev A et-al. A rare cause of multiple cavitary nodules. Chest. 01;136 (1): 306-9. doi:10.1378/chest.08-2354 - Pubmed citation
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- 8. Sidhu HS, Bhatnagar G, Bhogal P, Riordan R. Imaging features of the pleuropulmonary manifestations of rheumatoid arthritis: pearls and pitfalls. Journal of clinical imaging science. 1: 32. doi:10.4103/2156-7514.82244 - Pubmed
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