Rheumatoid nodules usually occur in association with rheumatoid arthritis, but may occur in with scleroderma or lupus. The rapid increase in size and/or number of rheumatoid nodules in a patient with rheumatoid arthritis treated with methotrexate has been called accelerated nodulosis.
Firm, chronic, dermal nodules occur. Lesions most commonly overly the elbows and knuckles.
No treatment is needed. In unusual situations, excision may be done.
For methotrexate-induced nodulosis, the methotrexate should be stopped if possible. D-penicillamine has been helpful [J Rheumatol 1999;26;1396] as has colchicine [J Dermatol 1999;26;691-4].
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