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 propotion 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
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.
- seronegative spondyloarthritides
- Jaccoud arthropathy
- juvenile idiopathic arthritis
- lyme arthritis
- rheumatoid arthritis
- systemic lupus erythematosus
- erosive osteoarthritis
- osteoarthritis (mnemonic)
- primary cystic arthrosis of the hip
- rapidly destructive osteoarthritis of the hip
- secondary synovial osteochondromatosis
- miscellaneous disorders
- related articles
- 1. Tanaka N, Kim JS, Newell JD et-al. Rheumatoid arthritis-related lung diseases: CT findings. Radiology. 2004;232 (1): 81-91. Radiology (full text) - doi:10.1148/radiol.2321030174 - Pubmed citation
- 2. Kobayashi T, Satoh K, Ohkawa M et-al. Multiple rheumatoid nodules with rapid thin-walled cavity formation producing pneumothorax. J Thorac Imaging. 2005;20 (1): 47-9. Pubmed citation
- 3. Capobianco J, Grimberg A, Thompson BM et-al. Thoracic manifestations of collagen vascular diseases. Radiographics. 2012;32 (1): 33-50. Radiographics (full text) - doi:10.1148/rg.321105058 - Pubmed citation
- 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
- 6. Shaw M, Collins BF, Ho LA et-al. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015;24 (135): 1-16. doi:10.1183/09059180.00008014 - Pubmed citation
- 7. Ost DE, Gould MK. Decision making in patients with pulmonary nodules. Am. J. Respir. Crit. Care Med. 2012;185 (4): 363-72. doi:10.1164/rccm.201104-0679CI - Free text at pubmed - Pubmed citation